If ear cartilage is used for a revision rhinoplasty procedure, is the ear effected in any way? Where is the cartilage taken from and is it noticeable?
Answer:
If ear cartilage is used for revision rhinoplasty, it is taken from areas in the concha bowl that should have no effect on the appearance of the ear. If the grafts are taken well and appropriately, whether it is one ear or both ears, you should not be able to see afterward that anything was done to the ear. And the ear cartilage is an excellent cartilage for work over the tip of the nose.
Hi! I am Dr. Epstein. I am with a patient today who is around 10 weeks status post rhinoplasty of African American ethnicity. That is the only identifying characteristic I am giving so she can stay anonymous.
Her main complaint was that she wanted to preserve her ethnic features which we all agree is important but at the same time she was concerned about the width of her nostrils that especially extenuated when she smiled. You can see how wide her nasal tip appears on smiling. She has a pretty smile but this really became the focus, that very wide nostril area. You can see from another before view.
What I did for her was a combination of refining the tip, narrowing the nostrils. You can see her here and you can see how nicely she has healed and the greater symmetry. She is still a little bit off but there is just a limit to the amount of symmetry that I can create.
You can see if we look down at the bottom view she had an external approach. You cannot even find the incisions, barely if at all perceptible. I also made incisions inside the nostrils to go ahead and deal with the nostril narrowing. You can see I was able to bring it in quite nicely.
Smile for me. You see when she smiles now she still has some widening but at the same time she goes ahead and it is a more refined look.
She is around 10 weeks post operative. We may want to do a little touch up at some point just to bring in one of the nostrils to create a little more symmetry but that was the challenge that she did have this asymmetry.
She is happy and she was nice enough to sit for the video.
DR. EPSTEIN: Hi! I am Dr. Epstein. This is one of my favorite parts of my job which is taking off the splint when the patient has had a rhinoplasty. In this case my patient is six days status post a rhinoplasty.
You can come in and see what some of her concerns were. She had a hanging tip, over-projected profile. You can see especially when she smiled the tip would get pulled down and she just had an overall wide look to the tip of the nose and took away the attention of what really is what I think is her prettiest features which are her eyes.
She is six days out and here she is. Today we are going to go ahead and take her splint off, which is always the fun part. You can see the stitches done here. We have already taken the tape off from the tip of the nose.
This is a little bit sore. We are going to go real gently on her. We are going to gently go ahead and take this off and then we are going to get to see at the same time she does what her nose looks like. She has a nice smile and you can see when she smiles her tip does not come down nearly as much.
I have no idea what her nose looks like but I am assuming that it is healing up the way we want it to. Feels good right?
PATIENT: Feels great!
DR. EPSTEIN: Chin up for me. Turn around this way Michelle and lets go ahead and take a look. You can see now what we have done for her is taken down the bump, did a lot of refining here in the bridge. This is probably pretty tender in here. Give me a smile. The tip stays up much more elevated. What I like to do at this point is put some tape on the bridge of the nose. We will let her take a look at it in just a minute.
As I said she is exactly six days out from her surgery. It was done through what is called an external approach. The reason I like this tape is it lets you see sort of what it looks like once the swelling goes away.
We are going to sit her up. Now we get to take a look. There you go! You are still quite swollen here and you can see how the bridge has been narrowed and the profile.
PATIENT: It's pretty! I'm so excited!
DR. EPSTEIN: What is going to happen over the next week or two is the swelling is going to go away. As I said, her tip was rotated up through a lot of different maneuvers because that was one of the biggest issues. To me the three main issues were the tip hanging down, the broad tip sort of a little bit wide and fat, and then the wide bridge. All those things were set in. You can see when I press down the nasal bones have been brought in quite a bit, the tip has been refined but it is still swollen and lastly the tip has been rotated up, not too much but enough to add to this.
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