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How involved is taking out a calvarial bone graft, reshape it and re-insert?

Q:

I had a nose job 5 weeks ago. After a week I realized with HORROR, that my nose bridge was huge and that I had a hump. I never had a hump. With no more swelling on my bridge I see the implant fully: sides, top and how misshapen and larger than necessary it is. My PS is not telling me how he can fix it. Can this be rasped under local anesthesia? Can I go to a different surgeon? Also, how long do I wait? I feel my skin stretching, I am scared.

A:

 

 I am sorry to hear about the unfavorable outcome occurring with your Rhinoplasty. It sounds like your surgeon placed an implant or other material to accentuate part of your nose. Start with your surgeon. Write down on a piece of paper your issues. Then, calmly point out your concerns to your surgeon and ask how each will be addressed. Write down the answers for your own edification. Request a copy of your operative report from your Rhinoplasty surgeon.

 If you are not satisfied seek a consult from one of the many members of the ASAPS. It is perfectly fine to seek out a second option. It is your nose. Please make sure to again take your written concerns and a copy of your operative report with you to the visit. It is also helpful if you have photographs of your face before the surgery. Best,

 

Gary R Culbertson, MD, FACS 

A:

Removing, reshaping, and replacing a calvarial bone graft is not hard if it it done skillfully by an experienced surgeon.  I have had to do it on my own patients occasionally.  Therefore, do not worry.  I have never seen such a graft come through the skin, which seems to be one of your concerns..

 

You must, however, wait long enough for the tissues to soften so that the revision will be maximally  successful.  If the dorsal graft is very bad,  I have revised it in 6 months but done nothing else.  If you can wait a year, that is better.  Make sure that you see someone who does this surgery often--the graft is there for a reason.

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