Cartilage for Bridge Augmentation?

I just went to Asia for rhinoplasty & contacted a lot of board certified plastic surgeons there but they all wanted to use silicone & said they did not use cartilage for the bridge, only the tip. That made me confused. Cartilage can be used for the bridge, right? If septal cartilage can be used to augment the bridge, then would it feel weird in a way? I'm a bit worried because cartilage is softer than bone...? Wouldn't my nose bridge feel softer? Please help clarify, thanks.

Doctor Answers (11)

Cartilage for nasal bridge augmentation

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Cartilage can be used to augment the bridge and the tip of the nose.  In Asian patients the amount of augmentation required is rather significant and the septal cartilage is typically thin and insufficient to give the correct augmentation.  For that reason, we use silicone implants in the bridge but use cartilage grafts in the tip.


Seattle Facial Plastic Surgeon
5.0 out of 5 stars 55 reviews

Cartilage for Nasal Augmentation

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Asian Rhinoplasty – Globally, the most common used augmentation material is silicone implant. It is a reasonable procedure and if done properly can be long-lasting. However, in the U.S.A. and in my Asian patients, I only use autologous tissue in the septum such as ear or rib cartilage as this provides a more natural, long-lasting effect. It does, however, require more expertise and experience in shaping and positioning of the dorsal graft.

Rod J. Rohrich, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 15 reviews

Dorsal augmentation may be done with cartilage grafts, medical implants, or fillers

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When treating the nose surgically, most surgeons in the U.S. prefer to use the patients own cartilage, either from the septum or the ear.  The body accepts it well and the risks for infection are far less than with medical implants like silicone or goretex.

Dorsal augementation can also be done quickly and safely in the office non-surgically using fillers.  Non-surgical augmentation of the bridge can be done with Restylane, Perlane, Radiesse, or Artefill.  The augmentation is done in about 15 minutes and lasts for about a year.

 

Good luck in your search for information.

David Mabrie, MD
Bay Area Facial Plastic Surgeon
4.5 out of 5 stars 56 reviews

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A difference in risk and approach

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Silicone or PTFE (Teflon or Gore Tex) implants are very common and popular in Asia.  The surgery is shorter and often less expensive.  In most cases patients do well long term.  However, every rhinoplastic surgeon in the US has probably seen the complications.  We have all probably seen patients who move here and whose implants get infected.  Sometimes it is the result of gentle trauma to the nose and sometimes a sinus infection.  Sometimes there is not clear precipitating event.  The treatment is removal of the implant and antibiotics.  The infection can rarely be a life threatening issue.  I have probably removed 10 of these over a 30+ year career.  While is is not wrong to use an artificial implant to augment your nasal bridge, I think I am on safe ground to say that the more accepted approach in this country is to use cartilage.  It is really kind of routine to an experienced rhinoplastic surgeon. Septal, ear or rib cartilage is common.  Rib is most commonly a fall back for second or third revisions.  I have  attached a link to some photos from my website of a young lady augmented with septal cartilage.   

Stuart H. Bentkover, MD
Boston Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

Cartilage for bridge augmentation is an option if....?

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Thanks you for your question. Your concerns are commonly heard in my practice. Asian rhinoplasty typically involves augmentation of the tip and bridge. Because the required augmentation for most prospective Asian patients is significant relying solely on septal cartilage is not recommended.  To obtain the required mass needed for augmentation options include implants (such as Gore-Tex or silicone) or grafts (rib cartilage). Because both implants and grafts are solid in nature the will "feel" in line with you current bridge. Both implants and grafts can be used safely and effectively for ths purpose.  The choice really relies in your surgeons particular experience with a particular implant or graft. 

Edward S. Kwak, MD
Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 5 reviews

Bridge Augmentation in Rhinoplasty With Cartilage

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Cartilage from a variety of donor sources can be used to augment the bridge. The use of silicone implants is much easier on both the surgeon and the patient but may have signficant long-term issues. Whether your septal cartilage can be used alone for your bridge augmentation depends on your desired aesthetic result. Silicone implants create a degree of augmentation that septal cartilage can not usually achieve. If your goal is a large dorsal augmentation, you may have to consider rib cartilage to get enough graft material.

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
5.0 out of 5 stars 26 reviews

Cartilage for Nasal Bridge Augmentation

+1

Over the past 35 years I've never use silicone to augment the nasal bridge because of the risk of movement or extrusion of the implant. I always use the patient's own cartilage which will become incorporated into the patient's surrounding tissue. It will look and feel normal.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Silicone implants for dorsal augmentation versus cartilage

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Septal cartilage can certainly be used to augment the bridge, but it typically does not yield enough cartilage to produce a significant augmentation.  Surgeons will recommend what they are most comfortable with, and silicone implants are very popular in Asia because they are tolerated fairly well along the dorsum for patients with thicker skin.  They are a quick and easy way to build up the bridge.  However, they come with an increased risk of complications including infection and extrusion.  For this reason, IMHO, cartilage is a better option achieve a lasting, attractive result.  For dorsal augmentation in asian rhinoplasty, typically additional cartilage is necessary from the ear or rib.  

Donald B. Yoo, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 18 reviews

Cartilage for the dorsum of the nose

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I use cartilage for most patients that require dorsal nasal augmentation. It is either harvested from the patient or used from a cadaver.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Cartilage Grafts for The Asian Nose, Silicone (Silastic) vs Cartilage

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Cartilage or silicone can be used to augment the dorsum of the nose.  Silicone (silastic) has no real size limitations from the standpoint that you can buy as big a piece as you might want.  However, artificial materials in the nose are more prone to complications including extrusion (eroding through the skin or through the interior mucosa and coming out) as well as infection.  These problems are more common the bigger the graft.

Either product if done properly should feel quite normal when you push on the nose.  Cartilage and silastic are similar in that they are hard but bendable.  If you try to squeeze of compress either, you will not be able to.  However both will bend which is important since the nose should be bendable.  If properly placed, both will be firmly attached to the underlying bone and cartilage and thus not move around independent of the nose.

Cartilage is not as abundant as silastic.  Obviously, you can buy as big a piece of silastic as you want.  Septal cartilage is somewhat limited.  Generally I find that most Asian people have enough cartilage in their septum to produce a nice dorsal augmentation.  If you really want a strong profile, then you will need to consider silastic or rib cartilage.  I do not like rib cartilage because it has a problem of warping months to years after surgery.  Also, rib cartilage harvest leaves a visible scar and the procedure carries a very small risk of causing a pneumothorax.  Ear cartilage is also available, abundant, low risk to harvest, and leaves a scar that is essentially invisible.

I find that a double or triple thickness dorsal graft of septal cartilage will generally result in a stronger nose that still retains ethnic Asian qualities and thus looks quite pleasing on an Asian face.  Ear cartilage is often times used by me for the tip since it fashions quite nicely into the shapes appropriate for that area and allows for the maximum usage of septal cartilage in the dorsum.

Louis W. Apostolakis, MD
Austin Facial Plastic Surgeon
4.5 out of 5 stars 15 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.