The Use of Cartilage Grafts in Rhinoplasty

Is grafting necessary in rhinoplasty?Many patients are concerned about the cosmetic after effects of using cartilage grafts during a rhinoplasty procedure, often because of something they’ve read on the Internet. In fact, far from being a dangerous practice, the use of cartilage grafts is almost always a necessary part of the surgery. Rhinoplasty patients, like patients in all other areas of medicine, should be as wary of “information” they read on online as they are of rumors and gossip they hear offline.While it is true that cartilage grafts have the potential to become visible, especially in patients whose skin is thin, cartilage grafting is essential in almost all rhinoplasty procedures in order for surgeons to provide their patients with satisfactory aesthetic results. In fact, cartilage grafts of varying types are used by just about every well-known, talented rhinoplasty surgeon.When Grafting Is Absolutely NecessaryFor many patients, the lower nose is the area that makes the nose unattractive. This typically occurs in patients with weak, drooping cartilage at the tip of the nose. For these patients, cartilage grafting is the core of improving their appearance because it enables the surgeon to strengthen and reshape the structure of the nasal tip.How is cartilage grafting used? During a rhinoplasty procedure, the surgeon, wherever possible, uses the existing nasal cartilage during reshaping. In many cases, however, there isn’t enough tissue, or the existing tissue isn’t strong enough. This may happen because of inherent characteristics of the patient’s tissue or because the nose has been previously operated on. In the latter case, a large part of the nasal skeleton may be missing and the tissue that remains may be quite damaged. Rather than remove more tissue (which could exacerbate the deformity), the surgeon will rebuild the nose with grafts from donor cartilage.Where does the cartilage for grafting come from?Donor cartilage usually comes from another part of the patient’s own body. Three possible areas are considered for harvesting tissue: the nasal septum (septal), the ear (conchal), or the rib (costal). When such tissue from the patient is unavailable for some reason, tissue is taken from the irradiated cartilage of a cadaver.What makes the use of cartilage difficult for the surgeon?The gifted rhinoplasty surgeon functions as an engineer, an architect, and a sculptor as well as a surgeon. He or she must consider:

• Contour, symmetry and proportion
• Harmony with other facial features
• Skillful and secure placement of grafts
• Prevention of excessive bleeding and swelling

To make the surgeon’s job even more challenging, pitfalls such as skin fibrosis, cartilage warping and wound contracture must be avoided. Bear in mind that above and beyond all these considerations, the surgeon is working, when inside the nostrils, with limited visibility.Because the use of cartilage grafting is only one of many reasons that rhinoplasty is a complex procedure, patients should choose their surgeon with great care, only putting themselves in the hands of a practitioner whose stellar track record speaks for itself.