LAM FACIAL PLASTICS

Hi Dr Lam,

I had revision nasal surgery with cadaver rib grafts in 2009 (in CA), to repair an over-resected/fattened/V-deformity/over-rotated primary rhino outcome. I'm female with fair to olive, moderately thick/oily nasal skin. The short term revision result was GREAT! Unfortunately, the dorsal rib graft 90% reabsorbed within 6 months. My tip grafts appeared to remain, but it has now de-projected and rotated up again, 2.5 years down the track. The aspect I struggle with the most is I now have nostril show more than ever before and a bowed columella. I am tall and have very hairy nostrils - not great to have them on show so much! I just don't look like "me".

The bridge was patched up with ear & fascia under local numbing in 2010, but in a crooked way causing a lump on one side where it deviates and a large indented look on the opposing side. it has also left me with a lumpy looking bridge, despite fascia and thick skin. Breathing is very restricted on the deficient side.

As an ENT/Plastic surgeon, do you see many grafts reabsorb like this? What do you like to use in the bridge and tip for longevity?

I am hoping to find a revision specialist who can rebuild my bridge and tip so it looks more balanced & whole - also to improve my breathing. I'm told my skin is in good condition, which is one bit of good news (I am 29, healthy and a non-smoker).

Sincere thanks

1. i rarely use rib for this reason. however, in many cases rib grafts are just fine. i prefer gore-tex but in multiple revision cases i do not because alloplasts have a higher risk of infection in multiple cases where that is quite rare in patients who have only had 0 or 1 case prior.
2. if the areas just have skin dents i prefer to use injections to manage the situation, e.g., with silicone micro injections, artefill, or restylane. i would only do that if you are not planning to have further surgeries as fillers can muck up the blood supply more if there would be additional surgery.
3. for the breathing, i would have to look in your nose. sometimes a turbinoplasty on that side can open things up. however, if there is truly external valve (nostril) collapse then you might need additional alar cartilage grafting to stent the side wall out. i would again have to see you to decide the best course of action.
best,
sml