What is a graft and what is it used for in rhinoplasty?

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.

Grafts usually refer to pieces of cartilage that can be taken from inside the nose( the septum) form  the ear, or even from the rib to be used for camouflage or projection deficiencies such as on the dorsum of the nose or the tip.  These are mainly used for aesthetic improvement but can be used for functional problems such as for breathing disorders.

A graft is a piece of cartilage taken from within the nose or behind the ear.    It is used to build up the nose for structural integrity, improve breathing or to enhance the appearance of the nose.  Cartilage from the nose is the preferable graft.   

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.

Possible risks

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.