Is Ear Cartilage Too Weak to Make Lateral Crural Extension Grafts?

After Septo-Rhinoplasty, I now require lateral crural extension grafts due to valve collapse.

However, my doctor is unsure whether I have enough septal cartilage left to make the grafts with and has suggested the use of my ear cartilage if there is not enough.

However, I am concerned as I have now been informed by another doctor that ear cartilage will be too weak to use. Is this true? Thank you.

Doctor Answers 10

Ear cartilage for lateral crural extension grafts to correct valve collapse

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Technically speaking, you are raising 2 different points: Valve collapse and nasal alar collapse.

Collapse or rather pinching of the nasal valve is caused by undue narrowing of the middle of the nose. This condition is USUALLY treated with SPREADER GRAFTS placed along the top of the septum to increased the horizontal space for breathing and recreate the valve.

Over resection of the lower lateral cartilages (the staves creating the tip AND keeping the nares opened) or destroying their support on the pyriform aperture can cause pinching or collapse of the nares on deep inspiration. To repair/correct this, extra-anatomic grafts of cartilage are placed to stiffen the alae to prevent the pinching and these are CRURAL EXTENSION GRAFTS.

The septum is ideal for BOTH of these grafts, the ear cartilage a close second. I have never encountered an ear which was totally unsuitable, although I am sure that if the patient had a history of operations to the ears, that may be the case.

Good Luck.

Memphis Plastic Surgeon

Ear cartilage should work in most cases

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Most surgeons prefer septal cartilage for tip reconstruction when it is available. However, ear cartilage is a wonderful material for supporting the lateral crura with grafts. It is flexible but has some firmness and has a natural curvature similar to the normal lateral tip cartilage. The answer to your specific question of whether it will be adequate really depends on your anatomy and the extent of your valve collapse. In cases where there is significant loss of support in the setting of thick skin, ear cartilage may not be enough, but in our experience that is a very rare situation.

Good luck with your revision.

Jason Litner, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 52 reviews

Lateral Crural Extension Grafts

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This is not an easy question to answer without examining your ear and nose. The fact is, some ears have firm stiff cartilage that would work especially in a nose with weak thin lower lateral cartilage. On the other hand, if you have weak ear cartilage and firm thick nasal cartilage then this would not work as well. Generally, the best material for a lateral cural grafts are septum and rib cartilage. I have used ear in a number of cases with very good success. The best thing you can do for yourself is to make sure your surgeon is an expert rhinoplasty surgeon with lots of experience with these types of cases. Best of luck.

Dr. Karam

Amir M. Karam, MD
San Diego Facial Plastic Surgeon
4.7 out of 5 stars 124 reviews

Tissue for lateral crural extension grafts

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This is a very technical question. You using a very precise term. A lateral crural extension graft usually refers to a non-anatomic graft placed from the pyriform aperture to the lateral crura. Many physicians use septal cartilage. A double stacked ear cartilage may be an option, some surgeons use rib. To best know what to use in your case you need to consult an expert rhinoplasty surgeon. Best of luck.

Robert Mounsey, MD
Toronto Facial Plastic Surgeon

Lateral crural extension grafts can be used from conchal cartilage

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Lateral crural extension grafts can be used from conchal cartilage. The only down side is they will be stiffer and more firm than nasal cartilage. Make sure that your surgeon has performed thousands of rhinoplasty surgeries and has many years of experience performing these types of grafts.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Ear cartilage may weaken over time

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Ear cartilage may work but may weaken over time. Rib is the best cartilage to use for this procedure. Hope this helps answer your question.

Dr. Nassif

Paul S. Nassif, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 49 reviews

Lateral Crural Grafts from Ear Cartilage

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These should work just fine. The strength is good enough to avoid collapse of the nasal alae on inspiring.  I have found the cartilage from Triangular fossa (part of the ear) works well to create a relatively flat graft that fits in well.


Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 126 reviews

Ear Cartilage is Acceptable in Rhinoplasty

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Ear Cartilage is perfectly acceptable for structural grafting in rhinoplasty. However, it is a clear second choice to septal cartilage; in my hands it is used in circumstances where septal cartilage is unavailable because it fractures more easily and is naturally curved in shape. Although rib cartilage is preferrable for structural reasons, the donor site morbidity and risks involved with harvesting it make it a third choice.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 103 reviews

Ear Cartilage Can Work

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I would agree with the other surgeons that a second opinion may be in order with an experienced revision rhinoplasty surgeon. While ear cartilage can be used for lateral crural strut grafts, the more important question is - is this the right procedure.

D.J. Verret, MD
Dallas Facial Plastic Surgeon

It is not to weak.

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 See an experienced revision rhinoplasty surgeon since this will require a great deal of expertise. It's about the skill of the surgeon in making the lateral crura strong enough.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 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.