Answer: With a Revision Rhinoplasty, almost any graft from the Primary Rhinoplasty can be removed in the hands of a highly experienced Revision Rhinoplasty specialist, but with caution and meticulous dissection so as not to cause injury to other structures. However, you have also expressed that 5 years after your Primary Rhinoplasty from another surgeon, you are experiencing discomfort and awkwardness during kissing from a nasal strut, significant tip asymmetry and alar retraction. Most grafts do not feel uncomfortable, but may look too full or visible. Alar retraction in nasal surgery is rarely caused by the placement of a graft, but is more likely due to too much resection of the cephalic margin of the lower lateral cartilages or the vestibular skin underneath them, or by filling out the columella so much that the alae look retracted. If there is nasal tip asymmetry after the first rhinoplasty, it could be secondary to many possibilities, such as healing contraction, a migrated graft, or bossa formation. Most columellar struts go between the medial crura and should not be causing a kissing problem unless they shift. Patients with post-operative concerns many years down the road should take great care to visit an expert Revision Rhinoplasty surgeon (most likely a facial plastic surgeon) for a thorough nasal assessment. It may be that removal of the grafts alone may or may not completely resolve the outlined concerns and an individualized treatment plan should be developed for the greatest success.
--- Dr. Russell Kridel, Houston, TX