Revision Rhinoplasty on Rib-cartilage-instilled Nose?

Q: Hi I had a rhinoplasty done with rib cartilage to lengthen my nose as well as to sharpen the nose tip. I feel my nose tip can be slightly sharper. Is it possible to use more rib cartilage to sharpen it?

A: Are you 2 years out from your rhinoplasty with rib cartilage?  If not, give it a full two years to see if the tip becomes “sharper” as it heals.

If you are more than 2 years out, then certainly things can be done to create more tip definition.  You may or may not need rib cartilage as there may be sufficient cartilage in your septum or ear to provide graft material for your tip.  Keep in mind also, that the thickness of your skin may also limit the degree of definition you will be able to achieve.

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Nearly 3 Weeks Since Rhinoplasty, and I Have a Small Bump on the Bridge of my Nose, Will It Go?

Q: My surgeon reduced my tip making my profile smaller, and thinned the bridge of my nose a little bit, I had internal and external splints, a little after 2 weeks I began to feel a bump on the right side of my bridge, below my eye. I do not understand, I never even had one their before, it doesn’t go when pressed carefully. When I feel it, their is more prominence on my right side however I can feel its slightly raised nearly to the other side. Will it get bigger and will it go? I feel so anxious 🙁

A: It could be cartilage or bone, but unfortunately without examining you it is impossible to guess which.  In this situation your surgeon will be in the best position to provide you with an accurate answer.

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Unhappy After Second Round of Rhinoplasty. What Can I Do?

Q: First Rhinoplasty: 10 months ago. Main concern: hump but bridge was narrowed, cartilage removed from tip and lifted. Had to go back in March as I developed a huge hump on the side where original hump was removed – nose looked crooked. After second surgery still a hump – it feels like cartilage and not happy with tip. Also have a lot of scar tissue. Afraid to go back to original surgeon. Rhinoplasty revision specialist here in SA doesn’t want to operate ever – What to I do? – Can’t accept my nose!

A: Seek other revisions rhinoplasty specialists and get another opinion.  Many offer Skype consults to make it easier for you to have an initial visit.

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Revision Rhinoplasty in March. Still Have Hump, But it is Soft?

Q: Hi there – I had Rhinoplasty last November and a small revision at the same surgeon in March this year since my nose was crooked after the operation due to a bigger hump on the one side. I now still have a hump on the same side but if feels soft – if I press on it, it will go down only to stand back up after a few seconds. Can this be cartilage? I can almost feel the rim…. Must this be corrected surgically or will it go down with time? Thank you.

A: If it’s soft, it could be cartilage or it could be skin or the underlying subcutaneous tissue.  If it’s cartilage, it will not resolve with time.  If it’s just scar tissue or swelling in and under the skin, it could go down.  Touch base with your surgeon as she/he will be best suited to answer.

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How Difficult is It to Fix a Pinched Bridge?

Q: Hello, I got my first revision about 3 months ago to fix pinching, but the sides of the bridge is still pinched. The tip looks great but the bridge still looks pinched. Not as bad as before, but it is still pinched. How can this be fixed? Thanks.

A: A number of approaches can be used to improve the appearance of this “pinching” along your bridge (dorsum).  The best option as mentioned is probably with revision rhinoplasty with placement of spreader grafts – which will address the underlying collapse of your middle vault which is creating the pinched appearance.  Another approach, which is reasonable if nasal obstruction is not a major complaint, is to camouflage the depressed “pinched” areas.  This could be temporarily with a dermal filler, or more permanently with a cartilage graft – either an onlay graft or diced cartilage.

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I have an Asian bulbous nose. Which procedures would be best for rising the bridge and giving the tip more definition?

Q: I have an Asian bulbous nose that I would like slim down with rhinoplasty. I would also like the bridge raised and the tip defined. Any recommendations on what procedure to go with and what would be necessary to achieve my desired outcome (and if it is even possible with my current nose)?

A: There are many options when choosing Asian rhinoplasty, but the safest, most permanent and predictable way to achieve excellent results is with tissue from your own body (autologous grafts).  The choice of cartilage grafts will depend on the degree of augmentation and refinement you desire.  If you like very refined, tall noses, rib cartilage may be the best option for you.  I am a strong proponent of building the bridge with a diced cartilage fascia graft, and reinforcing your tip with cartilage grafts to increase the projection and refinement of the tip.
Computer morphing of your nose during an in-person consultation with a rhinoplasty specialist would more definitively determine the best grafts for your nose.

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Asian rhinoplasty using rib cartilage. How long would it take to heal?

Q: I’m Filipina with a flat bulbous nose. I was wondering if harvesting rib cartilage, how long will it fully heal? My PS says he needs to use rib cartilage for a significant change. I also want to get a breast augmentation done 3 months after Asian rhinoplasty, but I am worried because my PS will have to operate on my chest to harvest my rib cartilage for my nose that it will take a while to heal.

A: For the most significant change in Asian rhinoplasty, rib cartilage is the best choice for a number of reasons.  The rib and chest will be somewhat sore for the first 4-5 days after surgery, and sutures are removed a week after surgery.  By the second week, most of this soreness has resolved and patients may resume light exercise after 2 weeks.  At this point the incision line is typically well-healed.  By 4 weeks full exercise may resume.  A 2 cm linear scar hidden in the crease below your breast is all that remains by this point.

The incision for rib cartilage harvest is typically smaller and more medially placed than the incision for breast augmentation, and should not affect it.  Nearly a third of my female patients have had breast augmentation, and the rib harvest is performed entirely below the breast, and does not interfere with the implant or breast at all.

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Plastic surgeons who are experts in doing Asian Rhinoplasty, Cheek Augmentation, Chin Implants & Eyelifts!

Q: I want to get Asian Rhinoplasty, Cheek & Chin Implants, Eyelid surgery that would help correct downturned droopy eyes. To save money I’d like to do all this in just one procedure. I found this plastic surgeon who is an Asian rhinoplasty specialist but he doesn’t do cheek implants. I found another surgeon who does cheek implants but is not an expert in Asian rhinoplasty. How do I find a plastic surgeon that is an expert in all these fields? I don’t want to get out of surgery looking like a monster.

A: Personally, I feel the goal of cosmetic plastic surgery should be to enhance and highlight your natural beauty.  That being said, as others have mentioned you already have an attractive face, and you don’t need dramatic changes to enhance this.  A rhinoplasty would help to improve the balance and harmony of your face, but cheek implants and drastic eyelid surgery may make you less attractive instead of more.

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I’m Filipino – Can I achieve a nose with Asian Rhinoplasty?

Q: I’m Filipino. My nose is flat and wide, and is bulbous. Can I do Asian rhinoplasty using only ear cartilage and septal cartilage? I want the bridge taller and a bit thinner, and I want the tip more refined. Are my expectations realistic enough?

A: Using grafts fashioned from cartilage from both your ears and septum, and fascia harvested from your scalp, it is possible to achieve a result similar to the photos you have provided.  The diced cartilage wrapped in fascia (DCF) can be used to augment the bridge of your nose to make it taller and thinner, while a combination of grafts can be used to project and refine the tip of your nose.

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Is it a good idea to get an Asian Osteotomy?

Q: Is it even a good idea for one? What exactly does it do and what look will it give? I feel that my nose root in very deep/sunken into my face and want to push this area out. Will a osteotomy help with projecting my whole nose outwards?

A: The majority of patients undergoing augmentation Asian rhinoplasty will not benefit from osteotomies.  Especially patients with a deep radix (root of the nose), building this area and making it taller will improve the appearance of the bridge and correct the dorsal aesthetic lines without the need for osteotomies.  Autologous grafts (such as diced cartilage fascia – DCF) fashioned from ear or rib cartilage, will project and refine the nose.

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