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                   Dr. Azizzadeh Primary

What is Rhinoplasty?

These pages will have an archive of all the rhinoplasty content and discussion we had on our site. A lot of usefull information will be in these archives. Over 100 pages of content will be added.

I just want to say that this was my first open procedure done in all 4 rhinos. I say go for it open because just from what I can see now, there is no insight greater than actually seeing what you are building. My scar tho is at the very base of my collumella because of my particular situation. Don't fear the scar, rear the bad result from docs working basicaly in the dark, unfortunately like Gruber did on mine in 96 which caused me to use the dammed filler silicone anyway to correct the flaws.


too soon for you to judge this. since you just had surgery.
give it a year...then you can judge how your nose has coped with the open compared to the closed technique.


You are right of coarse, but I have never seen such symmetry in my columela and nostrils ever. That's all.


While a surgeon will always recommend the approach that he was trained in or is most comfortable with, I disagree that a closed surgery is the best choice for a revision that requires significant grafting.

My revision surgeon was trained in both open and closed surgery but he will never do a closed revision simply because when you have had tissue removal in a primary (bone, cartilage) the best way to repair it is to see the existing structure of the nose in front of you. My primary was closed and I was left with tremendous asymmetry that wasn't obvious the first year or so after surgery.

I consulted with a doctor who only does closed surgery (primary and simple revisions) that require work around the alar rims and he said he couldn't help me because I would need an open surgery to address the tip asymmetry in the best possible way. I have never heard of a complex revision done closed. Even though there is more swelling and scar tissue with open the chances of you getting a symmetric outcome if you have grafting done are far greater with open surgery. There are tons of papers on the subject on e-medicine, BTW.

In Michael's case where the PS had to separate silicone from the skin, while leaving enough healthy tissue to form pockets for grafts and so that his circulation wasn't destroyed causing tissue death, I'm sure Michael is extremely grateful that he had an open surgery.


Thanks so much for your input. I appreciate you backing me up on this. Unfortunately as supportive as these boards are there always has to be someone who who needs some conflict. I am trully greatful for dr Quatela's sensible, artistic and skilled approach. For example my columella was always a problem so by shortening it and giving it support it becomes less of a problem to perfect where in some circumstances tissue just won't do what you want it to. MichaelA.


Hey Michael:

If I was having a primary for a minor bump removal I probably wouldn't want an open surgery because of the swelling. But like I said, having gone through a couple of revisions, I personally feel better about someone not working blind when it comes to graft placement. Toriumi and several other docs that I consulted with who do open revisions told me they will place the grafts and then pull the skin of the nose down over the structure to see how it is draping and taking it's new shape. It may take them a couple of rounds of adjustments to the grafts to get the shape they are aiming for. From a purely logical perspective, it makes sense to me.

I don't know if you were on the boards when JT was posting, but he also had a surgery with Gruber and had major problems with his columella afterward. It had completely retracted. He also had numerous other structural issues.

Hang in there, focus on positive energy and healing. I've heard great things about Dr. Quatela as a surgeon and a human being. You've been through alot, and deserve a major break and good things coming your way. Stress is bad for you immune system!!


Hi I was wondering if you know if JT ever found someone to revise. I also have the problem of retracted columella and am wondering what doc could fix this and what is the best graft to use. A few docs suggested an onlay graft which will improve it but I think I need more.


Hi Kim:

Yes. JT went to Dr. Toriumi for his fix. The last time he posted which was almost a year ago he was happy with the outcome. Dr. T attached a long columellar strut made from rib cartilage to the nasal spine that was attached to the columella in the front on his nose creating a more normal frontal angle. I remember that JT said Dr. T said that was the only way to fix a retracted colummela. From what I understand, in his previous surgery, JT's columella had been knocked off his nasal spine, so it looked pushed in or almost flat. I think Dr. Gruber had tried to reattach it without much success. The nasal spine is the bone at the top of your upper lip right below the base of the nose. I hope that helps.


Yes thank you for that information. Very helpful. I wonder if T is the only doc who does that graft. I consulted with T and he thought my nose looked ok considering that my doc did a lot worse things to people's noses. T didn't think it was worth me going through a 7hr surgery with the rib etc


From my experience, I think the strut is pretty common in revisions to help reinforce the tip of the nose. Every doc I consulted with recommended the strut. I actually had one put in in my first revision made from septal cartilage but it didn't do anything. I know that it was made too short but I don't know if the failure was also because it wasn't stiff enough as a rib cartilage graft would be.

If that's the only thing that is wrong with your nose and it's not too severe then I can see why extracting rib would be a major ordeal. I know in JT's case he also needed his radix built up so T had to a few areas to address with rib grafts.

Sorry to hear your surgeon failed you. I can relate :(. It may seem minor to Dr. T but I suppose it's how you feel about living with it versus enduring a long surgery and healing time. Do you also need other things done? He wasn't estimating 7 hours just for the strut was he?