Liz came into me for a revision rhinoplasty. She told me that shes had two previous rhinoplasty surgeries. She was unhappy with the way her nose appeared on her face. She felt it was asymmetric, the tip was kind of bulbous, or large appearing, especially when she looked up, this view, it was very asymmetric. And so, her whole goal was to make it look better, hopefully make it her LAST surgery, and also to help with her breathing.
With my examination of Liz, I found that most of the septo-cartilage, which is the septum inside here between the two nostrils, which is a great source of cartilage was GONE! The next thing we can go to is the ear. The problem with the ear cartilage is that its too soft and too curved, and if you want to do something strong for the nose and give it really good shape, you cant use the ear. So, we had a talk about using rib cartilage.
One of the things thats very important about revision rhinoplasty that you always have to consider is; What are you going to find in there? Even though you can feel the nose, you can palpate it, you can look at it, and you can guess what the other doctors have performed; your first up-hill battle is to see how much scar tissue youre going to be able to identify with. So when you have to open up the nose, you have to remove the scar tissue, identify it: whats there, whats present, whats been removed. Then after you do that, and you have cartilage now ready for grafting, or fascia, or perichondrium, you have to start rebuilding it.