Reabsorption rates of ear and septal cartilage.

Question

I will be undergoing a nasal reconstruction surgery. I would like to discuss reabsorption rates of ear and septal cartilage. I will be using ear cartilage for tip to enhance the cephalic strip of the lower lateral crura. Ear and septal cartilage will be used to augment the upper lateral cartilages. When cartilage reabsorbs, does it disappear uniformly or do random depressions form? Does this occur in a year or is ther much longevity to ear and septal used for dorsal augmentation?

Alejandro Nogueira, MD · Answer

If you could please post images, such revision plan sounds strange to my ears, specially the augmentation plans mentioned, probably you are not using standard phraseology.
Regarding resorption; that is a good point, in practical terms it is almost not existant, however all revision and ethnic rhinoplasty surgeons we do know this is a risk; how to prevent that:
-performing meticulous elevation of the skin cover of the nose without damaging it or the inner mucosa lining, both layers are an essential vascular sandwich to provide nourishment to the "hungry" cartilage grafts
-permorming meticulous and exhaustive debridement (removal) of any fibrosis or poorly vascularized tissue, in order to increase blood supply to grafts
-never leaving / preventing any kind of exposure, specially internal to the airway, of the grafts
-never using crushed or diced grafting (what a dredful fashion using diced cartilage!)-performing meticulous harvesting of the grafted parts, great care has to be taken not to damage the grafts or both the donor site
Following these rules it is close to zero the chance of resorption; early infection could be a little less likely, but normally is well controlled with antibiotics.
If late resorption occurs, and my career of hundreds of grafted cases, revisional and primary ones, I had only 2 cases of resorption, one of them was in my mind since the case was desperate with terrible previous damage to the vascularity of the nose, so was an expectable resorption, the other one was non expected. Resorption happens between the 2nd and the 8th posop month, never later than 1 yr, and normally it is a complete resorption, the whole grafting dissapears. In such eventuality and if the surrounding vascular environment makes it recommendable the grafting can be repeated.
If you wish better grounded opinion please do post or send privately well lit, focused and standard images: frontal, both lateral and both oblique views, also underneath the nostrils.
Feel free to request any additional information from me.

Manish H. Shah, MD, FACS · Answer

Hello,Thanks for your question. Solid graft segments tend to have minimal absorption. As you crush the cartilage, then resorption increases a bit but is typically not complete. Surgical technique and soft-tissue bed characteristics will determine the health of the graft ultimately.Good luck,Dr. Shah

Summit Kundaria, MD · Answer

RevisionSeeker23,
Thanks for your question.  Both sources of cartilage, auricular and rib, give lasting results (years and years) when placed with good technique and in a  healthy tissue bed.  As this surgery's aim is to address the form and function of your nose, I would not concern yourself about what would reabsorb at which rate.  I think that the better question is "will these cartilage sources give me lasting results?", and I say that both can, given good technique.  Good luck!

Reabsorption rates of ear and septal cartilage.

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Reabsorption rates of ear and septal cartilage.

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