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Rib Grafting for Revision Rhinoplasty in Beverly Hills
By admin | November 17, 2011
Rib Grafting for Function and Cosmetic Correction of Noses with Septal Perforation
Last week I performed perhaps the most difficult Revision Rhinoplasty of my career. This nice man had a history of nasal collapse secondary to a huge perforation of his septum from previous history of medications and chronic trauma to his nose. Septal perforations can be fixed if they are very small but the larger they are, the harder they are to fix. Septal perforations are irreparable if they become too large. To put this in perspective, a perforation the size of q-tip head is fairly easy to fix. A perforation the size of a dime has a very high rate of failure when correction is attempted and a perforation the size of a quarter is uncorrectable. This man had a perforation the size of a silver dollar. The reason that this is important is that the septum provides the support for the nose the same way the studs and beams inside the wall support the wall support the wall. Any trauma or insult to the septum puts the nose at risk of collapse which is why you see professional boxers with saddle nose deformities (because their septums become destroyed from repeated trauma). It is taught that someone has a septal perforation is not a candidate for rhinoplasty because the lining of the nose and perforation will weaken the support as I described above. I always have subscribed to that teaching until this particular person entered my office. This man has changed his life around and no longer does things that are detrimental to his nose or body. The appearance of his nose has severely affected his self esteem and is a daily reminder of the life and person he once was that he is trying to forget. He had been rejected for years by surgeons who he consulted with to fix his nose. I felt compelled to step outside the box if possible to help him move on with his life. He fully understood the risks associated with rhinoplasty and he desperately decided to proceed. I told him that I may be able to achieve a 5% improvement in his appearance and he thought that even that small amount would make him happy.
I performed a rhinoplasty using his own rib cartilage to rebuild his nose. During surgery, I proceeded very carefully step by step making sure not to violate the tiny amount of support that he had to his nose. At any step I was prepared to abort the mission if things looked too tenuous. As I proceeded I could not believe how much improvement I was able to get. I expected 5% improvement and I was looking at more like 95% improvement. Furthermore, I was able to increase his support by using rib cartilage so his nose is actually stronger following the rhinoplasty. He is now 1 week out from his revision rhinoplasty and I am astounded at the results! Never in my wildest dreams did I think I would be able to achieve this result. This is one of the most rewarding procedures that I have ever done and needless to say he is absolutely thrilled and amazed with his results.
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