I am currently seeking a revision rhinoplasty to build up the bridge and reduce the width of the nostrils and slightly rotate the tip down. I was wondering which material or method to build up the nasal bridge…. Gortex Implant or Rib Graft? Also, have you ever had a case where you were able to give the appearence of a Roman nose, from a smaller flatter nose.?
It sounds like your nose underwent an over-aggressive reductive rhinoplasty. This often can create a short, upturned nose. The problem has to be diagnosed and then the solution devised. The issue may be over resection of the septum or the lower lateral cartilages or the upper lateral cartilages or bone or a combination of these issues.
To correct what was done and create a stronger more natural nose or “roman nose” the tip has to be de-rotated and the dorsum (top) has to be rebuilt. There are many ways of doing this ranging from the use of implants such as silastic and Gortex to the use of natural cartilage.
I much prefer natural tissue to implants. Implants can become infected, can shift and can be extruded. Cartilage can also resorb or warp but when used properly the benefits outweigh the risks.
The use of “caudal septal extension grafts” and the use of tip grafts and spreader grafts and onlay grafts make up the core of the revision rhinoplasty. There is also a type of graft known as the D.A.R.T. graft that can also be used.
I have had many such unfortunate patients who have undergone successful revision surgery. The Dr. known most for creating very strong “roman” noses is Dr. Dean Toriumi in Chicago if you would like to see more than one surgeon (which I urge you to see even more until you have found the right surgeon for you.