Would A Secondary Cleft Rhinoplasty Be Safe?

Q: Dr. Eppley, I am interested in a rhinoplasty. I am 50 years old and was originally born with cleft lip and palate. I have had two previous rhinoplasties for my cleft nose, the last being over a decade ago. I have never really liked the results and was hoping to have one more go at it in my older years. Just recently had a consultation about my nose with  a  surgeon who is basically a cosmetic surgeon. He looked me in the face and said  that due to my anatomy and blood supply, his major concern was that he wasn’t sure if he could correct anything. His concern was necrosis. I have great blood supply and have never heard of that possible complication before. As a matter of fact that remark caused me to realize that I needed an expert in cleft nose deformities. Please tell me what you think.

A: While open rhinoplasty always has the potential for nasal tip skin necrosis, this would be a very rare problem. The surgeon would have been better to say ‘I am not interested in doing your nose’, ‘this is hard and not worth my effort’ or even ‘this is beyond my skill level’ but the idea that the blood supply to your nose is compromised and can’t be operated on is not a valid biologic concept. If that were true, the vast majority of revisional rhinoplasties would never be done, not withstanding the secondary cleft rhinoplasty.

Dr. Barry Eppley

Indianapolis, Indiana