This is a very interesting question. Remember the goal of rhinoplasty is to achieve the most aesthetic, pleasing, and structurally harmonious nose for that face. There are many factors that go into achieving this goal. When a patient comes to me for revision rhinoplasty it’s clear that they are unhappy with the results.
The decision-making process must require a complete and thorough physical exam and a thorough discussion with the patient regarding their goals. If I believe that simply removing the graft would then achieve the best result than possibly simply removing the graft would be possible.
However more likely after a complete and thorough physical exam of the nose both internal and external with detailed measurements, simply removing the graft may not be advisable. Keep in mind that cartilage graphs over time could possibly irrevocably fixate to the patient’s underlying tissue and therefore complete removal may not be feasible. Possibly, removal can only be achieved in a piecemeal fashion leaving a less desirable result than the graft itself.
Revision rhinoplasty by its nature is a very challenging project. Scar tissue, skin thickness, and missing internal structures may hinder achieving the optimal result. It’s essential that anyone seeking revision rhinoplasty choose their surgeon carefully. The best way to evaluate capability in my opinion is to review the before-and-after gallery of the revision section. If there is no revision section I would be very hesitant to seek revision from that individual surgeon. Also, a review of the before and after gallery will tell the tale of the surgeon’s experience.
Revision rhinoplasty is a very significant part of our practice. We go to great lengths to evaluate suitability for surgery and are thoughtful in achieving a plan to obtain the best most elegant result possible for that patient.