Cartilage from Another Person in Rhinoplasty?

Question

I'm considering revision rhinoplasty and I need grafts for my slightly upturned tip and bridge. Recently, I went to consultations for revision. I was very suprised when surgeon said that patient's own cartilage is not good source in revision rhinoplasty. He said that our own tissue (cartilage) is too soft and will warp with time. The only solution to achieve long term result is to take tissue from another person. I am very sceptical about it and I would like to hear your opinion. Thanks

Thomas A. Lamperti, MD · Answer

I've never heard that a patient's own cartilage is worse than cartilage from someone else. Some surgeon's will use cadaver rib cartilage that has been processed for use in another patient, though this is usually only used if the patient's own cartilage is no longer available (from prior surgery).

Anil R. Shah, MD · Answer

Your own cartilage is better than cartilage from another person (safe to say we are talking about irradiated rib).  Why is your own cartilage better?

	1.  Your own cartilage has living cartilage cells called chondrocytes which will stay alive when moved from one area of the body to another.  These chondrocytes get their blood supply and nourishment from the surrounding tissues.  You can "bank" cartilage behind the head and it will stay alive if necessary.  Irradiated cartilage does not have living cells in it.  Essentially, you are placing a hopefully inert substance in the body.

	2.  There is less chance for infection with your own cartilage.  If there is an infection with your own cartilage, it is more easily treated.  With irradiated rib, more often the rib cartilage will likely need to be removed.

	Irradiated rib is not necessarily always a worse choice.  Irradiated rib does not require a harvest site, either ear or rib.  irradiated rib also is the only optionin some patients older than 50 as their own rib cartilage can become calcified and not useable later on.

David C. Pearson, MD · Answer

It's complete nonsense to claim that one's own cartilage is inferior to irradiated cadaver cartilage (the only other source of cartilage for the nose outside your own tissues).

	Ideally, we use the patient's own septal cartilage. It's strong, living, and completely bio-compatible, of course. Ear cartilage is okay, but has its drawbacks in terms of quantity (limited), shape (it's curvy), and strength (it's elastic cartilage, not hyaline). In the "cartilage depleted" patient who does not want his/her own rib cartilage used, irradiated rib cartilage from a cadaver can be the next best alternative.

	Hope this helps,

	--DCP

Adam D. Stein, MD · Answer

That is certainly not correct IMHO. Although it is true that cartilage from your own body can resorb and even warp occasionally with time, most experienced rhinoplasty surgeons would tell you that using this material is by far the best material for reconstructing the nose. If there is septal cartilage, that is usually used first. If there is no septal cartilage left from previous surgery, then most surgeons would choose ear cartilage or possibly rib cartilage depending on what it will be used for. In either case, material harvested from your own body is usually considered best.

Michel Siegel, MD · Answer

Not all cartilage is the same, and it depends how the cartilage will be used. For structural support septal cartilage would be excellent, for contouring of filling a defect ear cartilage would be an acceptable choice. If not enough cartilage is available from your own body, because it was already removed during a previous surgery, or not enough is availabl, then your choices would be to use rib cartilage. some surgeons prefer to use the patient's own rib cartilage,  while others prefer to use it from a donor (usually cadaver)
So the answer really depends what the cartilage will be used for, and how much is needed.

Francis R. Palmer, III, MD (retired) · Answer

I sincerely hope that this is a joke.  I have never heard anything more blatantly absurd than those statements.  You can not use another persons tissue in your body without causing a serious and possibly life threatening rejection.  Run, do not walk away from this person and please see a qualified Rhinoplasty surgeon for a second opinion.

	If the surgeon was talking about irradiated, banked, donated cartilage this is another story as radiation has be applied to the cartilage making it useable however, it is not true that it is superior in any way over your own cartilage as grafting material, IMHO.  For the nasal tip there is no better graft material than your own ear cartilage.

Cartilage from Another Person in Rhinoplasty?

Answers (6)

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