Fixing A Botched Rhinoplasty

As a patient, getting a good rhinoplasty result depends on several factors, some of which are controllable and others are not. One of the most important factors is finding an experienced Albany rhinoplasty surgeon. This may be a difficult thing to find, especially in certain regions. The face is how we greet the world, and if you’re considering nasal surgery, it is a good investment to find an experienced surgeon, even if that entails some travel. Another related factor is finding a rhinoplasty surgeon that shares your goals and your artistic vision.

Finding Your Rhinoplasty Surgeon

Every surgeon has their own philosophy of rhinoplasty and their own vision of the perfect nose, and if these ideals do not align with your own then unhappiness may result. It is worthwhile to spend some time looking at the before-and-after gallery of your candidate surgeon to see if you share a similar vision. An uncontrollable factor is wound healing. Each person’s body has a unique biology, and everyone will heal slightly differently. Even the most well executed surgery may heal poorly for reasons that are unclear. All of these factors, when taken together, result in a national average revision rhinoplasty rate around 10%.

Transform Your Appearance

One common goal of patients seeking rhinoplasty is to transform a nose that is large and turned downward to one that is smaller and turned upward. For many people in years past, this meant a surgery which entailed removing a large volume of bone and cartilage to reduce the size of the nose. In a relatively large percentage of patients, this resulted in an unstable or collapsed nose.

This collapse is visible as a concave nasal dorsum, and this is termed “saddle nose” deformity. In addition to a less than ideal nasal appearance, this deformity is frequently associated with breathing problems. Saddle nose deformity is a frequent reason that someone may desire a revision rhinoplasty. For this reason, our philosophy of rhinoplasty has always focused on rebalancing the nose to better fit the individual’s face, rather than simply reducing the size of the nose.

Correction of a saddle nose deformity involves building an underlying structure that is aesthetically pleasing as well as strong enough to support the soft tissue of the nose. In most cases building this structure will require the use of graft material. Generally speaking, there are 2 main categories of graft material: tissue grafts and synthetic implants. In rhinoplasty, synthetic implants are less ideal due to higher rates of infection and extrusion, and therefore we preferentially use tissue grafts.

One type of tissue graft is referred to as “irradiated cartilage”, which is taken from one person, treated with radiation, and sterilized for use in another person. The long-term durability of irradiated cartilage is questionable, and for this reason we prefer to use tissue grafts that are taken from the patient themselves, which are termed “autologous grafts”.

In revision rhinoplasty when there is no septal cartilage remaining, there are two main sources of autologous graft material, ear and rib. The choice between these two sources depends on the volume and quality of cartilage needed for repair. Ear provides a relatively small amount of flexible cartilage, whereas rib provides a relatively large amount of stiff cartilage. Rib cartilage is used preferentially for correction of a saddle nose deformity. Although rib grafting is not risk free, most patients who undergo rhinoplasty with rib grafting do very well, and rib grafting remains one of the best options to correct major nasal structural deformities.