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                   Dr. Azizzadeh Primary

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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.

Long term graft results. Someone posts for a short while then disappears. Some are happy at first then trouble starts. I'd be curious to know of anyone with a good long term rib revision.


Could it be that people stop posting because they are glad to finally put their surgeries behind them and move on with their lives? I can't think of a more depressing place to be than a rhino revision board if you are happy with your outcome. The only difference between rib and ear is the warpage factor. The risk of rib warping only applies to pieces longer than 15 mm. Anything shorter and it's no different than grafting with ear other than it's less lumpy. Both can resorp to a degree but rib actually has a lower resorption rate than ear. If rib is going to warp it happens fairly soon afterwards--once you get past the danger zone you are home free.

Gunter has been rebuilding noses with rib for years. If it was such a complete failure I doubt that the leading surgeons in the country would be risking their reputations to put it in thousands of noses. Just a thought.


Toriumi mostly uses rib for noses that need bridge work or spreader graft now his spreader grafts do run longer than 15mm and start at 22mm and get longer depending on the facial structure. I wonder what is the chance of bending when it is used for spreader grafts then? Also the bending can happen over time it is true that you are at higher risk imediatly but you are not safe even years after the surgery. That is why he likes to observer his patietns even few years pass their surgery to see how every thing stand the test of time. With all that it seems to be the best tehchniques he got and he gets better result with it than ear so they are not much choices. at This point what I would be concer with T's surgery is his thurst for big bulky noes!!!


He also uses rib for tip grafts, alar struts and colummelar struts and alar battens which are not longer than 15 mm. Most of his patients now are getting all rib unless they need alar rim composite grafting.

Toriumi observes ALL of his patients for two years if they comply with all of the follow-ups--not just rib patients. In addition to watching long term outcomes, he also publishes a lot in periodicals and books. In order to publish he needs to follow long term large groups of patients who have had the same procedure. He told me that it is extremely unlikely to get warping after the first two months with his carving technique. If it's a major concern just don't get the rib graft. It ain't a perfect world folks.


If not doing the revision was mentally an option I would not do it, but unfortunately I am tired of this situation and want to get it fixed but also want to make sure I study every thing before going through with it. Do you know what width on average he uses on his spreader grafts did you ever discuss that with him?



There is no such thing as an average width, it depends upon the patient's nose and is up to the doctor's discretion--whether you need spreader's for aesthetic reasons or functional reasons or both. It also depends on the width of your nasal bones which the grafts get attached to and what would be needed to either keep the flow of your nose consistent from top to tip or to improve it. I have been told that the range in general for spreader grafts is between 2mm and 8 mm.


thank you, I did not realize that it could go as wide as 8mm, that will explain how some times some of his noses get really wide. It seems to be a bit unpredictable how some times his noses are on the smaller size and not wide like ND or Nora and some times he makes very wide noses(from the top to bottom) like some of the pics we have seen.


I was actually given that width range by another doc but he said that was a general rule of thumb for spreader grafts. I suppose if you have valve collapse and an inverted V your middle vault may be pencil thin and require some serious widening. Is ND, the woman Nikki who was contemplating surgery with T last year? Did she have a successful revision with him? Good for her. Did you ask T in MM's how wide he would make your middle vault?


I am sorry, I meant to say NR, ND I believe is having surgery this year. Anon I need to talk to you about some information that I think is importnat for you to know given how much research you have done regarding this revision and T. Please email me privatly.