Options for Cartilage Grafts for Rhinoplasty

Where you get the cartilages to build the bridge of the nose and the tip in a rhinoplasty? how do you  shape the cartilage to make the nose look how the patient wants?


Doctor Answers (13)

Cartilage for the nasal tip in rhinoplasty

+2

In primary (first-time) rhinoplasty, building up the nasal tip may be done any of a number of ways. Yes, they all involve the use of cartilage, but in some cases it may not necessarily require the use of cartilage 'grafts', which are pieces taken from another area and moved to the nasal tip.

I believe you are asking what we would use in the latter case. If necessary, cartilage may be taken from the nasal septum itself, which is nice because no more visible external incisions are used.

Another area is the concha cavum or concha cymba of the ear (the part that sits relatively flat against the skull). This can be done rather inconspicuously.

Another area that we can use is the rib. This would involve a small incision on the chest. Typically, this is reserved for situations where a large or very firm piece is required, and the septum or ear will not do. This is often used in revision surgery, less so in primary rhinoplasty.

Regarding shaping the graft, no textbook can teach a surgeon like experience. Factors to consider are the overall nasal tip shape desired, its relation to the rest of the nose and face, as well as ethnicity, gender, patient height, etc. Finally, technical considerations include how thick the nasal skin is, as well as how well supported the tip is.

Hope this helps,

Dr. Sam Most


Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 32 reviews

Cartilage grafts for rhinoplasty

+1

The best and most common cartilage grafts employed when needed in
rhinoplasty are taken from the nasal septum and from the ears. In
special circumstances, when there are severe deformities related to previous surgery and/or trauma, and when there is no good residual nasal septal or ear cartilage remaining, grafts may be obtained from rib cartilage or from irradiated homograft bank cartilage. The cartilages are hand carved, shaped and sculpted to conform to the need and deformity of the nose in order to create the desired structural contour.

 

Sigmund L. Sattenspiel, MD
Freehold Facial Plastic Surgeon

Cartilage graft options for rhinoplasty

+1

The best cartilage grafting for rhinoplasty is always taken first from the septum. This is the cartilaginous dividing line between the left nostril and the right nostril. If all of the cartilage in the septum has been depleted, the second best is ear cartilage. If the ear cartilage has been depleted and more cartilage grafting is needed, then a rib graft would be the third choice. The cartilage grafts are simply shaped with a knife and cutting board to make them appropriate size, shape, and thickness to fit and balance with the new rhinoplasty.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 56 reviews

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Cartilage Grafts for Rhinoplasty

+1

Cartilage grafts for augmentation rhinoplasty are taken from the nasal septum, the ear, or the ribs. The grafts are carved so they are not visible after surgery. Fascia grafts can also be used in the bridge depending on the location and severity of the depression.

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

Cartilage grafts in rhinoplasty [with video]

+1

Your question is a good one.  Cartilage is what makes up much of the structure of your nose, both aesthetically and functionally.  When I perform rhinoplasty in Santa Barbara, I work to improve both the form and function of the nose.  Often adjustment of the septum, the divider between the nostrils, can greatly improve the way the patient breathes.  This septum is made largely of cartilage, and so when the problematic cartilage of the septum is removed, it can be manipulated and used as a graft.

Additionally, removal of parts of some of the cartilage of the tip of the nose leaves us with some very delicate, thin pieces of cartilage that we can use for nuance grafts.  If neither of these areas are suitable for using as grafts, the ear is a great resource.  Small, well hidden incisions allow us to remove some of the cartilage from unimportant areas of the ears, and this can be used to help shape the nose.

Once the cartilage is obtained, there are several shapes that can be utilized, and several methods of shaping the grafts.  Often, particularly for structural grafts, the cartilage is literally sculpted with the use of the scalpel.  Alternatively, when subtle changes in nasal form are required, the cartilage can be "morselized" or crushed, providing thin, wafer-like grafts to use.

Rhinoplasty is one of the procedures that requires knowledge of nasal anatomy, as well as a great aesthetic feel for the nose and what looks right.  It is one of my favorite operations.  Several different techniques including suturing and grafting may be used, and the complex interaction of form and function help to make this operation very satisfying for surgeon and patient alike.

Adam David Lowenstein, MD, FACS
Santa Barbara Plastic Surgeon
5.0 out of 5 stars 22 reviews

Your nose can be reshaped with cartilage from your ear or rib

+1

Hello - In order to build up the bridge of the nose or reshape the tip, cartilage can be borrowed from your ear  or rib.  The cartilage is then shaped with a knife and/or stitches to obtain the ideal shape needed for your nose. 

Jeffrey E. Schreiber, MD
Baltimore Plastic Surgeon
5.0 out of 5 stars 69 reviews

Cartilage grafts for the nose

+1

The most popular source for caritlage from the nose, in order of preference, are:

  1. the septum'
  2. the ear
  3. the rib

Shaping is essentially accomplished through carving and sutures.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 44 reviews

Rhinoplasty and Nasal Cartilage Grafts

+1

Hi Scary,

The cartilage for nasal grafts in rhinoplasty is obtained most commonly and preferrably from inside of your nose, the nasal septum. The second choice is your ear cartilage, and lastly rib cartilage.

The grafts are carved by the rhinoplasty surgeon to the required shape and size. An experienced rhinoplasty surgeon knows how to construct, place, and secure nasal cartilage grafts to help their patient achieve their nasal cosmetic and functional goals.

It is up to you to choose your rhinoplasty surgeon most carefully.

Good luck and be well.

Dr. P

Michael A. Persky, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 23 reviews

Cartilage grafts in rhinoplasty usually come from the septum.

+1

The cartilage is shaped by carving it with a blade. The most important thing is the brain of the surgeon so you don't end up cartilage showing thru the skin. See an experienced rhinoplasty surgeon to get the best results.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

The best cartilage grafts for rhinoplasty are taken from the nasal septum

+1

Grafts are often used to strengthen the tip of the nose, but rarely used on top of the tip unless the patient has thick skin. The best source for this graft is the nasal septum. We often remove cartilage from the nasal septum when performing a Septoplasty As long as a good supporting rim is left behind, the septal cartilage will not be missed. The cartilage is shaped by precise carving.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
5.0 out of 5 stars 39 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.