COMPLICATIONS - GENERAL QUESTIONS

Question: What kinds of complications can occur in rhinoplasty?
Answer: Complications in rhinoplasty may be categorized as functional (related to breathing) or aesthetic (related to appearance); often, there are elements of both. Problems after rhinoplasty commonly are due to underresection (not enough taken off), overresection (too much taken off), and/or asymmetry. Also, sometimes abnormal scarring is a problem after rhinoplasty.

In general, it is easier to fix problems relating to under-resection, because they can be fixed by going back and "taking a little more." Problems caused by overresection can be a little more complicated because material needs to be added, and technical factors arising from the need to add tissue must be considered. Asymmetries can usually be improved and at times can be completely fixed.

Question: If you need to use grafting material to rebuild my nose, what kind of materials are used in revision rhinoplasty?
Answer: Whatever material is used, you should expect that you and your surgeon will discuss exactly what is to be used in your case.

Various materials are used. Most commonly, cartilage is taken from inside your nose (specifically the nasal septum) or from your ear. Less commonly, rib cartilage is used. This may be your own rib,or it may be specially treated, irradiated rib taken from a donor. Examples of each may be seen in the Photo Album.

Question: My skin is very thin. Do you take any special measures in my revision rhinoplasty?
Answer: In patients with very thin skin, even the slightest irregularity may be felt or even seen. In these cases, we consider the use of Alloderm. Of course, if this is a consideration for a patient, Dr. Becker discusses this with him/her in advance of surgery.

Alloderm is a non-cellular human dermis taken from an organ donor and treated with a patented, FDA-approved treatment. Alloderm is used in a number of facial cosmetic applications, including lip augmentation, scar revision, and rhinoplasty. In revision rhinoplasty in patients with extremely thin skin, Alloderm may be placed between the skin and the graft to thicken the skin and thereby provide additional camouflage for the graft.

This patient had a reconstructive rhinoplasty in which Alloderm was used due to his thin nasal skin.

Question: Why don't you use artificial implants?
Answer: Some surgeons use artificial implants such as gortex in the nose, but we do NOT advocate them. We feel that artificial materials carry the risk of becoming infected and extruding at any time. If these artificial implants come out through the nasal skin, this can cause irreversible damage to the nasal appearance.

The medical literature contains multiple reports describing this problem. Some surgeons who use this material have stated that they discuss this risk with the patient and make sure he/she understands the risks. We believe there are better options, and so we are not willing to take this risk when fixing your nose.

Question: If you need to take ear cartilage, how will that affect my ear?
Answer: The good news is that if you need ear cartilage for your revision rhinoplasty, taking that cartilage should not alter your ear's shape or function.

The septum is usually our first choice for grafting material. However, if you have already had a septoplasty or septorhinoplasty, then this source of grafting material may have already been used, in which case we turn to your ear.

The incision is usually placed behind your ear where it cannot be seen. Sometimes, though, for instance if you wear a hearing aid (the incision behind the ear can be irritated by your hearing aid during the healing process), we prefer to make the incision on the front side of your ear in a location where it is well-camouflaged and difficult to see.

The cartilage taken from your ear works well in rebuilding your nose. The good news is -- when performed properly, removing this cartilage should not change the shape of your ear! Occasionally, we see a patient who has had both ear cartilages used already, and they still need revision rhinoplasty. In these cases, we are sometimes able to find that there is still enough of the patient's own cartilage in the ear and septum, but we also consider the use of either the patient's or irradiated rib from a tissue bank.

Question: What about breathing and other functional complications?
Answer: Airway complications merit a website in itself; in brief, the surgeon must take a careful history and physical examination to identify which of the many causes of nasal breathing problems is affecting you. It is critical that during rhinoplasty, every effort is directed toward maintaining or improving the nasal airway. Failure to preserve nasal airway function can be crippling. The cause of nasal airway obstruction must be identified and addressed.

At the Penn Rhinoplasty Course, Dr. Becker gives a lecture entitled "Functional Considerations in Rhinoplasty." In this lecture, he emphasizes the importance of thoroughly evaluating the patient for nasal obstruction.

Ask Dr. Becker a question about revision rhinoplasty or make an appointment for a consultation, by calling 856-589-NOSE (6673) or emailing us at info@revisionrhinoplasty.com.