I don't know what is meant when doctors talk about grafts...what are they and what are they used for in rhinoplasty?
What is a Graft and What is It Used for in Rhinoplasty?
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Grafts in rhinoplasty are natural tissues used to improve the nose
A graft is any tissue that is taken from the body to use in another area of the body of the same person or another person. When we talk about grafts in the nose, we are talking about cartilage, soft tissue (fat and fibrous tissue), or sometimes bone that is used to improve the structure and shape of the nose.
Sometimes synthetic materials such as Silicone or Goretex are also used in the nose as implants. There are differences in the properties and uses of these materials. In general, the majority of grafts that are used in the nose are usually made of cartilage.
Cartilage grafts are small bits of cartilage that are carefully carved and shaped. They are used to either reinforce weak tissues or replace tissues that have been lost to trauma or removed during surgery. Most patients who require a number of grafts are seeking revision rhinoplasty to fix things after their nasal tissues have been too aggressively removed. Or, they may have a small nose or flattened bridge to begin with and wish to have it augmented, such as in some ethnic rhinoplasty. In these cases, it’s not uncommon for many different types of grafts to be used in the same nose, each playing its own unique role.
Patients seeking primary (first-time) rhinoplasty for reduction of a bump or for refining their features usually do not need grafts.
Contour grafts vs. Structural grafts
Grafts in the nose can be broken down into contour grafts or structural grafts.
Contour grafts are used when the surface or appearance of part of the nose needs to be smoothed out, better defined, or built up. We use these on the bridge when it is too low or scooped, on the side of the nose when there is an irregularity or a depression, or on the tip to change its shape.
Structural grafts are used when the nose needs more support such as when the tip is pinched and collapsing, or when the bridge is overly thinned and affecting nasal breathing. In these cases, the graft performs both functions: both improving support and nasal breathing, and achieving the look you want for your nose.
Where do grafts come from?
We prefer to use your own cartilage for grafts whenever possible. These can be taken from your septum (the center wall of your nose), the bowl of your ears, or your ribs. In any of these locations, you won’t miss the cartilage that is being ‘borrowed’. Your ear or chest should not look any different after this cartilage is removed.
The decision of where to take cartilage from depends on the amount, strength, and rigidity of the cartilage required. The appearance of grafts after surgery depends not only on the shape and size of the graft but on other factors. If your nasal skin is very thin, very precise details of the graft may show through.
That is not always desirable because tiny irregularities can be seen and the transition between the edge of the graft and surrounding tissue can be visible. In these cases, we may use some soft tissue over top of the graft to provide some thicker coverage under your skin.
On the other hand, if your nasal skin is very thick, a larger graft may be necessary to provide the definition you want or the support that you need.
With every graft that is placed, there is a small risk that it will be visible, that it might move, become infected or get absorbed.
We do things to prevent this like suturing the graft precisely in its place so that it has the best chance of healing well. For these reasons, grafts should only be used when and where they are needed. We weigh these factors every time we are considering using a graft. If your surgeon suggests a graft, you should have a clear idea of the What, Where, Why, and How of the whole process. Grafting should make sense.
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Use of grafts in rhinoplasty
A graft is a piece of tissue from one portion of the body which is placed in another. The most common grafts used during rhinoplasty are comprised of cartilage, taken from the septum, ear, or rib. The general purpose of these grafts is to change the shape of the nose by altering the underlying bony/cartilaginous framework. Certain grafts, such as spreader grafts, can be used to widen or support the nasal airway, to improve breathing. Besides cartilage, grafts can also be made of soft tissue, skin, bone or the mucosal lining of the nose.
Grafts in Rhinoplasty
Grafts are pieces of your own tissue implanted for filler, shaping, support, or to replace a missing piece.
In Rhinoplasty, grafts are most commonly bits of cartilage, often taken from the septum. The graft may be used for cosmetic shaping or for structural support to improve function (open the airway to help breathing).
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Grafting is a technique used in rhinoplasty
A graft is a piece of tissue used in rhinoplasty frequently. The purpose of the graft can be to correct irregularities, strengthen tissue or change shape. Grafts can be cartilage, bone, or soft tissue depending on the use.
What are nasal grafts?
A graft is any tissue taken from one place in the body and placed in another area. With Rhinoplasty most grafts are cartilage. Some are bone and rarely there are skin and mucosa. The cartilage can come from your septum or from your ear.
Grafts in rhinoplasty
A graft is tissue that is taken from one part of the body and transplanted to another. Grafts can be made of almost anything - skin, fat, cartilage, bone. In rhinoplasty or nose surgery, a graft is used to add structure to the nose or to support the functional portions of a nose (to help you breathe).
A simple way to view the nose is that most of the contours, the projections, and the size of a nose are formed by the underlying bone and cartilage. This is known as the "framework" of the nose. The skin and the fat which sit atop this framework are basically a cover. For the most part, in rhinoplasty surgery, the goal is to alter the framework to shape the nose. When you want to make things smaller, you simply remove some of the framework. When you want to accentuate areas, you often need grafts. These grafts are usually cartilage grafts and can come from your septum (in your nose), your ears, and even your ribs. By shaping and molding the cartilage grafts, a specific form can be created. In some instances you can even place the cartilage in such a way as to improve breathing in the nose.
Although this is a simplified description, I hope it gives you a basic understanding of grafts. Keep in mind though, an implant is not a graft. An implant is a foreign substance (silicone, gortex, etc.). Whereas grafts usually become incorporated into the normal architecture of your nose, an implant does not. This is not to say that one is better than the other, but you should know the difference if you are going to have surgery.
Grafts are augmentation places inside of the nose to...
Grafts are augmentation places inside of the nose to either provide structural support or cosmetic contouring. Usually the grafts are cartilage obtained from either the nose itself, the ear, or the rib but can be synthetic including silicone and Medpor among other things. Grafts may also be bone taken from the skull for reconstruction of the bone of the nose.
For patients who have experienced a traumatic injury to the nose or possibly disfigurement after cancer resection, a graft may be necessary to rebuild the underlying structure of the nose.
For patients wishing a different contour of the nose, grafts may be necessary to build up certain areas or strengthen other areas to prevent collapse after surgery.
What cartilage is used for graft tissue in rhinoplasty?
With revision surgery, sometimes all your natural nasal septum has been removed, in which case other options depending on where it is required from the nose include using ear cartilage (from a hidden part of the ear), or banked cartilage. The first option from your own cartilage septum is preferred, the other two options depend on the location and type of cartilage required.
For curved aspect of the nose that require strengthening curved, Dr. De Silva prefers ear cartilage as this creates a natural curve. For straight aspects of the nose that require straightening, Dr. De Silva prefers straight septum or costal cartilage. In some patients noses, different types of grafts are require to strengthen and support different aspects of the nose.
There are synthetic graft material that is available, however this is generally not preferred as it is unnatural and can have risks such as infection and exposure of the material.
Defining a graft for use in nose job
A graft is typically a biologic piece of material (most commonly cartilage but it can be skin, muscle, bone or fascia) that is used to achieve a desired change of the nose depending on what is required.
Grafts used in rhinoplasty
Grafts refer to any cartilage or other substance added to the nose during rhinoplasty surgery. Most commonly they are composed of cartilage, from either the nasal septum or ear, but occasionally they can be from a rib or a cadaver cartilage, or an artificial substance (which can work great) such as GoreTex. These grafts can be used for purely cosmetic purposes, such as with a tip graft along the dorsum/profile, or for both cosmetic and functional purposes, such as with a columellar strut to help hold up the tip or rim graft to give nicer shape to the nostril. To be used properly, grafts are usually best performed by an experienced rhinoplasty surgeon.