I realize that usually graphs have to be put in place. But what else does it mean? Can those graphs make the nose appear larger? Why do they say that having strong nasal cartilage is so much better to have? Thank you for answering! :)
What Are the Implications of Having Weak Nasal Cartilage in Rhinoplasty?
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Strong vs weak nasal cartilages in rhinoplasty
Weak cartilages need reinforcement in the form of grafts and structural sutures to give the nose shape and bend the skin but also to resist the forces of scar tissue contracture over many years. Very strong cartilages arent great either unless they are perfectly shaped and if youre going through a rhinoplasty, chances are your cartilages are not perfectly shaped. Medium strength cartilages are best just like medium thickness skin is best but we rarely find a best case scenario in thousands of patients who come for rhinoplasty.
Nasal Cartilage in Rhinoplasty
Cartilage and bone are the two types of tissue that provide support to the nose. If a patient has "weak" cartilage, then several different techniques must be used in order to both provide the appropriate amount of nasal support and to produce the cosmetic result desired. Suture techniques and cartilage grafts are the two most commonly used methods for creating nasal support or "strength" in rhinoplasty surgery. A columellar strut is a good example of a cartilage graft that is usually taken from the nasal septum and placed between and below the tip cartilage in order to increase nasal tip height, projection and support. When done properly and in combination with suture techniques, this should create an appropriately sized and aesthetically pleasing nose.
Weak nasal cartilage and rhinoplasty
Weak nasal cartilage usually means that the cartilages are very thin and atrophic and are easily collapsible. Certain types of grafts, such as a spreader graft, are used to bolster and strengthen and slightly widen the area of the nose where they are placed. They only appear slightly larger. At the time of your consultation for your rhinoplasty surgery, examination of the presenting anatomy will determine whether grafts are needed.
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Cartilage grafting can support weak nasal cartilages after rhinoplasy
Weak nasal tip cartilages can be diagnosed before surgery by careful examination. This condition predisposes to functional and aesthetic problems post operatively due to contraction and loss of support if not addressed with supportive measures, including structural grafting and sutures during surgery. These measures do not necessarily create deformity, but can actually enhance the long term results. Careful planning with an experienced surgeon is needed.
Weak nasal cartilage
If you have weak nasal cartilage in the tip, then removing too much of it could lead to collapse of the nostrils and problems breathing. You mention that usually it requires cartilage grafts. I disagree with that. I use cartilage grafts only occasionally and almost never with a primary ( first time ) rhinoplasty.
Will "weak cartilage" effect my rhinoplasty results?
Weak cartilage is actually a phrase I use often when describing cartilage quality to my patients. Cartilage can be weak in that it is thin, damaged (by previous rhinoplasty), or is in an improper angle/orientation. All this can be altered and should be worked on during your procedure to prevent future problems and need for revision surgery. Adding cartilage or re-arranging the cartilage you already have is key. I often have to completely re-sculpt, relocate, augment, or re-orient existing cartilage to create strength and shape that is aesthetically pleasing, simultaneously. You CANNOT have aesthetic nasal shaping without also maintaining or improving strength.
Use of nasal grafts in rhinoplasty surgery
Weak nasal cartilage may imply that there is lack of support to the nasal tip. You are correct that using cartilage grafts can help to provide structural support to the nose. These grafts will not make the nose look larger. If fact properly placed and used grafts will improve the overall shape of the nose.
What to do with weak tip cartilages
You must be a Beethoven fan. In any event, your question touches on one of the most fundamental issues in Rhinoplasty surgery. That is, the tip on profile should come to a defined point and be the most projecting part of the nose. If a person has weak tip cartilages, we now know that the solution is not to reduce the rest of the nose to try to make the tip the high point, but rather to use suture techniques or grafts, or a combination to accomplish that goal. Done in the usual fashion, these techniques should not make the nose appear larger. The reason it is better to have strong tip cartilages is that it eliminates the need for these other maneuvers. Also, if a person has thick skin, a graft may be necessary to create better definition of the tip.
What Are the Implications of Having Weak Nasal Cartilage in Rhinoplasty?
Weak nasal cartilages are less likely to provide adequate support or create a defined nasal tip. In a primary Rhinoplasty, with weak cartilages, there are two basic options on how to create both increased support/symmetry as well as a more tip definition. Which one is appropriate, IMHO, depends on the angle of nasal tip rotation.
- The nasal cartilages can be trimmed making the tip more refined and then the cartilage can be sutured together which creates added symmetry and support.
- The nasal cartilages can be trimmed making the tip more defined and then cartilage graft(s), I prefer using conchal ear cartilage for tip grafts, can be placed to create added tip definition and strength. Cartilage struts can be sutured inside the Columella (crural feet) for additional tip support if required.
In Revision Rhinoplasty, much less cartilage trimming is typically called for since this was most often done during the previous Rhinoplasty. The approach then becomes one of spot adjustments to make the tip appear defined, symmetric and natural in appearance using any and all of the techniques described above.
All of these options should be explained in detail by the Rhinoplasty Surgeon during the Rhinoplasty consultation. The Rhinoplasty Surgeon must, IMO, understand and follow the proper aesthetics of facial (and nasal) beauty for the creation of a naturally more attractive nose. Experience performing Rhinoplasty alone is simply not enough because using the wrong technique will not make the nose more attractive no matter how experienced the Rhinoplasty Surgeon may be.
Weak cartilage can be treated with cartilage grafts or fillers and non-surgical rhinoplasty
This is a great question! Having weak cartilages,very thick skin,or a combination of the two will cause a nasal tip to look undefined. Lack of tip defining points makes the nose look round and bulbous.
- Traditional surgical rhinoplasty addresses this problem by placing cartilage grafts. This is hard for patients to believe at first because the last thing most patients want to do is add to their nose. But if done well, adding cartilage can make a round nose look more defined. The key thing to realize is most patients think they want a smaller nose, but what they really want is a more defined nose.
- Tip definition can be improved with a non-surgical technique of adding fillers to the tip area- Yes, adding fillers can make the nose look more defined and seem smaller.
I am placing a link to case that demonstrates this point. Good luck finding information!
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.