I am having augmentation rhinoplasty, I have had rhinoplasty before to correct a saddle nose deformity. The first did not require any breaking of the nose or anything like that. I would like a larger nose all around. Including radix, middle vault and tip. This includes width and height. What's the best surgical method to produce a masculine nose on a Caucasian male? For instance bilateral spreader grafts, combination of fascia cartilage etc? I am having the cartilage taken from my ear.
Rhinoplasty Augmentation Methods?
Doctor Answers (9)
There are many ways to build up the bridge of the nose, using cartilage, bone or an implant made of silicone. The most important thing you can do, however, is be very careful in your choice of surgeon. You really need to find someone who is experienced with this kind of problem. Your average plastic surgeon simply does not see this problem frequently enough. Make sure you see a surgeon experienced in revisions and has dealt with your particular problem before and can show you pictures of patients similar to you.
Complete Dorsal Augmentation Rhinoplasty
By your description of a bigger nose, as defined by an increase from the radix down to the tip in both height and width, you are talking about complete dorsal augmentation. Depending upon how much change you desired, you are going to need a fair amount of cartilage or even an implant. Cartilage grafting is always preferred and you may need a rib graft to get the result you want.
The best alternative to build up the nose is nasal septal cartilage. Ear, rib and Silastic are also alternatives. Onlay grafts to the dorsum will build up the bridge while spreader grafts give more width to the nose. Grafts to the tip of the nose can be placed to widen the tip if necessary
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There are multiple ways to augment the nasal dorsum. Cartilage grafts of some sort are generally used for any dorsal nasal augmentation. Spreader grafts can create additional width to the mid-third of the nose. If you want to increase the profile of the nose an onlay graft of cartilage either contoured or as a diced cartilage wrapped in fascia both work well. Auricular, ear cartilage, along with rib cartilage can be used if there is not enough septal cartilage available.
Nasal dorsal augmentation
Augmentation of the nose can be performed with your own cartilage from the septum, ear or rib, or with tissue not from your body like irradiated cadaveric cartilage or synthetic products such as silicone or medpor. Fascia is OK for camouflage and blending of certain irregularities.
There are a variety of techniques used to augment the nose. These can be autologous (harvested from the patient) or synthetic. I prefer autologous sources of cartilage and/ or fascia. The commonest sites used for cartilage harvest include the nasal septum, ear or rib. I usually use fascia from the temporal scalp. Ear cartilage in your case may be the best option especially if you have had surgery before, and the septum is scarred. Although its difficult to to say specifically what is best for you without an exam, it sounds like a combination of spreader grafts and onlay grafts would be ideal. Good luck.
Ear Cartilage for Reconstruction
The use of ear cartilage may be appropriate in your case depending upon your current anatomy and specific goals. To make the nose wider, spreader grafts could be used. To increase the height a variety of onlay grafts can be used. Some prefer fascia surrounding diced cartilage.
Rhinoplasty to make the nose bigg
I have used cartilage and soft tissue grafts to make noses larger for 35 years and find this gives me the best way to solve different varieties of the overdone nose.
There are many different techniques and methods for augmentation rhinoplasty and these are dependent on each individual patient and their needs. Every patients facial aesthetics vary and so there is no "cookie cutter" process. Each nose is individualized in order to have a good functioning and aesthetically balanced result. Since you have already had rhinoplasty there may not be any excess cartilage in the nose and if this is the case then I personally prefer the ear cartilage. Best regards, Michael V. Elam, M.D.