For augmentation of a bridge, is it common to find enough septal or ear cartilage for a flat, Asian nose?

I'm hoping to heighten my bridge and would prefer not to use a silicone implant for fear of long-term issues arising. Also, I would like to reshape and build the tip of my nose with cartilage and wondered if there would most likely be enough from my own nose and ear(s) to do this without rib grafting; the recovery from harvesting the rib cartilage does not sound quick.

Doctor Answers 8

Options for dorsal augmentation during Asian rhinoplasty

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The recovery from rib cartilage may not be as intense as you are imagining.  The incision, in experienced hands, is minimal in size and hidden under the breast crease.  Immediately after the surgery you can expect soreness from the harvest site for 2-3 days, with improvement after that.  Some patients will have mild soreness - muscle soreness - for a few days beyond that, but rarely more than a week.  

The recovery from the rib harvest is simultaneous with recovery from your Asian rhinoplasty, so once the cast and sutures come off from your nose, your rib harvest site will be nearly fully healed.  

Depending on the height of your bridge before surgery, and the degree of augmentation you desire, you may have sufficient cartilage from your septum and one ear, your septum and two ears, or your surgery may necessitate rib cartilage.   

Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 64 reviews

Dorsal augmentation with nasal cartilage

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It is possible to augment  the Asian nose with the patient's own cartilage. Most Asian noses have  a very thin septum,  so the surgeon has to double stack or tripple stack the cartilage  required to augment the bridge. In our practice, we used Flowers nasal dorsal Silastic implants and have had an excellent success rate with them, as long as you don't try to over project the bridge line.

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

Silicone nasal implants may be well tolerated in Asian patients seeking dorsal augmentation Rhinoplasty Surgery.

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In our practice, we use custom carved implants of Implantech ePTFE for dorsal nasal augmentation. This has been well tolerated in our patients with very high satisfaction.

In South East Asia, silicone nasal implants are used with greatest frequency, as compared to other implants, and when placed properly, are well-suited for Asian thick skin. The risk of infection over a lifetime may be around 5%.

You may benefit from consulting several rhinoplasty experts so you could see what might be best for you.

Hope this helps you.

Dr. Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

Nasal a bridge augmentation

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There are a variety of augmentation materials that can be used to augment the nasal dorsum (bridge).
These include nasal septum, ear or rib (costal) cartilage.
For me, the decision is made based on how deficient the bridge is.  If there is a small deficiency, I often use diced ear (auricular) or septal cartilage placed in a fascial graft (usually temporalis fascia)
If the deficiency is larger and more augmentation is needed, I usually advise rib cartilage

Jonathan Sykes, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 28 reviews

Nasal augmentation of bridge

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Commonly if significant nasal bridge augmentation is required, a dorsal only from the rib or other source is necessary. I have used irradiated rib cartilage without having to harvest it from the individual.  This is one other option.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Augmenting Nasal Bridge

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I never use silicone implants for the reasons you mention. As long as nasal bridge augmentation is not part of a revision procedure, I've never had to use rib cartilage to augment a nasal bridge over the past 35 years. Septal and ear cartilage have always provided enough donor material.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Cartilage for Asian rhinoplasty

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Dear Crissy,

The answer to your question about asian rhinoplasty totally depends on how much height is required in the bridge and tip areas. An experienced rhinoplasty surgeon can give you an idea of how much can be achieved with each of the following options:
-septal cartilage
-ear cartilage
-rib cartilage
If you need a moderate amount of change, septal or ear cartilage is a good option. For more significant changes during your rhinoplasty surgery, rib cartilage is usually best. While the region is a bit sore for 7-10 days, the recovery is not nearly as bad as you might expect. I also think that it is a good idea to avoid silicone implants in the nose as you mentioned.

In your area, you might want to consider seeing Dr. Shan Baker at U of M for an opinion.

Best wishes,
-Dr. Asaria

Jamil Asaria, MD
Toronto Facial Plastic Surgeon
4.8 out of 5 stars 139 reviews

Asian Rhinoplasty, cartilage graft from the ears, Fascia graft

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Dear Crissy,
thanks for  your great question.
Based on extensive experience in rhinoplasty, I have found that sometimes, there is not enough septal cartilage available to be harvested while keeping the structure of the nose intact. 
For large volume requirements, one needs to harvest from the ears as well which is very easy procedure.
I typically, dice that cartilage and place it within the fascia graft for best cosmetic result.
Hope this was helpful.
Dr. Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 205 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.