How Often Do Cartilage Grafts Warp on Bridge of Nose?

There are a number of technical measures that can be employed to reduce warping of cartilage grafts over time.  The involve:


Where the graft comes from

How it is carved

How it is fixed to the rest of the nose

Whether it is one piece of graft or


Cartilage grafts on the bridge can produce very nice results

When cartilage is used as a graft material, it's stability over time may depend on the size, shape, location, and  source of a the graft.

Many smaller graft that are well covered by soft tissue are stable and do not change much. For a larger graft that is more visible, even a light position shift or warp will be more visible. 

Whether a patient needs an additional surgery to correct a graft warp,  shift  or size change depends on how dramatic the change is and how much it bothers the patient


 

I do not think anyone can answer your question because the warping can happen many years after the surgery. I am aware of cartilage graft to the nose placed around world war 2 whose warping became evident sometime in the 1960s. The photos were in a textbook of plastic surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

The incidence of cartilage grafts warping when used in rhinoplasty is directly related to three critical factors: 

1.     The source of the graft material.  In general, rib cartilage warps with much greater frequency than ear cartilage.  Nasal septal cartilage has the least tendency to warp.  During surgery, specific technical factors in the carving of the grafts will minimize the risk of warping.  Rib grafts to augment the nasal dorsum have typically been inserted as a shaped solid element or as a diced cartilage-fascial cylinder construct.  Each has its own pros and cons.  Solid rib grafts have the advantage of excellent structural support; however they also have the highest risk of warping.  In addition, the graft margins may eventually become visible, particularly in thin skinned individuals.  The diced cartilage-fascial tube graft does not provide quite the same structural support but has essentially no risk of warping, the margins blend in much better with the remaining nasal tissue and it can be effectively molded in the early postop period.  I presently favor the diced cartilage-fascia grafts when the amount of augmentation is mild to moderate and during ethnic rhinoplasty. 

2.     The size of the graft.  Large grafts carry a higher risk of warping than small grafts.

3.     The tension on the graft.  When placing grafts to reconstruct an overly reduced nose such as to increase nasal length or projection, the contracted skin and soft tissue envelope is being expanded and there will be a certain recoil force on the graft.  The resulting tension will act to deform the shape of the graft and the greater the force the higher the risk of warping.

Mario J. Imola, MD, DDS, FRCSC

.

 

IMHO conchal cartilage and rib cartilage/bone grafts, on the nasal bridge, can dissolve unevenly with time and for that reason I have not used these for over 22 years.  I prefer using a straight, silastic dorsal implant to build up the nasal bridge during Rhinoplasty.  Be sure that the Rhinoplasty Surgeon, you choose, understands and follows the proper aesthetics of facial (and nasal) beauty for the creation of a naturally, more attractive nose and face.

It is common for nasal cartilage grafts to warp.  This is somewhat dependent on the size and type of graft i.e. septum vs ear vs rib cartilage.  One way to decrease the warping is by chopping the graft into fine pieces and wrapping it in temporalis fascia.  Donald R. Nunn MD  Atlanta Plastic Surgeon.