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I've had several surgeries on my nose as a result of a car accident, and each time...

Q:

I've had several surgeries on my nose as a result of a car accident, and each time a graft was used. It has warped, resulting in a twisted nose shape. Are there some people that simply cannot have grafts used?  Or, is there anything that can be done to prevent the warping and twisting?

A:

Cartilage with its covering (perichondrium) has memory and may warp. There are certain steps to do with cartilage to minimize the warping.  It all depends on the source and placement of the graft, and how it is fixed.  Crushed or diced cartilage will not warp.

Since you have had multiple rhinoplasties, seek an expert in rhinoplasty.  The more surgery you do in the area, the more difficult it is to achieve good results.

A:

No one is unable to have grafts.  However, grafting, like any operation, takes experience and familiarity with various donor sites (septum, ear, rib) to be successful.  Rib is the commonest cartilage graft that twists, but I have used it many times successfully; however, rhinoplasty is also 90% of my practice.  Rib varies in tendency to warp with patient age - patients over the age of 40, after which rib grafts are stiffer, are therefore more reliable.  However, successful grafting should be possible at any age.

My best advice is to seek an experienced nasal surgeon in your area and ask to see examples of results that illustrate correction of your problem.

A:

Correcting a Twisted Nose – Correction of a traumatic injury to a nose is very challenging. The most important goal is to correct the septum. The key to reshaping the nose is by shaping the septum. One may require a rib graft and warping can be a problem with this graft.

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