What Are the Implications of Having Weak Nasal Cartilage in Rhinoplasty?

Question

I realize that usually graphs have to be put in place. But what else does it mean? Can those graphs make the nose appear larger? Why do they say that having strong nasal cartilage is so much better to have? Thank you for answering! :)

Robert Morin, MD, FACS · Answer

Cartilage and bone are the two types of tissue that provide support to the nose. If a patient has "weak" cartilage, then several different techniques must be used in order to both provide the appropriate amount of nasal support and to produce the cosmetic result desired. Suture techniques and cartilage grafts are the two most commonly used methods for creating nasal support or "strength" in rhinoplasty surgery. A columellar strut is a good example of a cartilage graft that is usually taken from the nasal septum and placed between and below the tip cartilage in order to increase nasal tip height, projection and support. When done properly and in combination with suture techniques, this should create an appropriately sized and aesthetically pleasing nose.

Bora Ok, MD · Answer

Hi from Istanbul, thanks for your question. Having strong nasal cartilages is crucial in rhinoplasty as they provide essential support, particularly in the tip area, creating more defined nose contours. Common issues, especially in ethnic rhinoplasty patients and those with thicker skin, include depressed, flat noses with poor definition and bulbous tips. These problems often stem from weak or inadequate cartilage. To enhance and refine these areas, to help support the new shape of the nose, cartilage grafts are typically used. Hope this helps.

Ronald J. Edelson, MD · Answer

If you have weak nasal cartilage in the tip, then removing too much of it could lead to collapse of the nostrils and problems breathing. You mention that usually it requires cartilage grafts. I disagree with that. I use cartilage grafts only occasionally and almost never with a primary ( first time ) rhinoplasty.

William Portuese, MD · Answer

Weak nasal cartilage usually means that the cartilages are very thin and atrophic and are easily collapsible. Certain types of grafts, such as a spreader graft, are used to bolster and strengthen and slightly widen the area of the nose where they are placed. They only appear slightly larger. At the time of your consultation for your rhinoplasty surgery, examination of the presenting anatomy will determine whether grafts are needed.

Ashkan Ghavami, MD · Answer

Weak cartilage is actually a phrase I use often when describing cartilage quality to my patients. Cartilage can be weak in that it is thin, damaged (by previous rhinoplasty), or is in an improper angle/orientation. All this can be altered and should be worked on during your procedure to prevent future problems and need for revision surgery. Adding cartilage or re-arranging the cartilage you already have is key. I often have to completely re-sculpt, relocate, augment, or re-orient existing cartilage to create strength and shape that is aesthetically pleasing, simultaneously. You CANNOT have aesthetic nasal shaping without also maintaining or improving strength.

Jeffrey Zwiren, MD · Answer

Weak nasal cartilage may imply that there is lack of support to the nasal tip. You are correct that using cartilage grafts can help to provide structural support to the nose. These grafts will not make the nose look larger. If fact properly placed and used grafts will improve the overall shape of the nose.

David C. Mabrie, MD · Answer

This is a great question!  Having weak cartilages,very thick skin,or a combination of the two will cause a nasal tip to look undefined.  Lack of tip defining points makes the nose look round and bulbous.

	 

	
		Traditional surgical rhinoplasty addresses this problem by placing cartilage grafts.  This is hard for patients to believe at first because the last thing most patients want to do is add to their nose.  But if done well, adding cartilage can make a round nose look more defined.  The key thing to realize is most patients think they want a smaller nose, but what they really want is a more defined nose.


	 

	
		Tip definition can be improved with a non-surgical technique of adding fillers to the tip area- Yes, adding fillers can make the nose look more defined and seem smaller.


	 

	I am placing a link to case that demonstrates this point.  Good luck finding information!

Peter E. Johnson, MD · Answer

When we refer to weak nasal cartilages in rhinoplasty the implication can be poor support with lack definition in the tip, or poor support of the airway. Fortunately, during rhinoplasty, we can use visible and nonvisible cartilage grafts to add structure, support, and definition when needed.

Shervin Naderi, MD, FACS · Answer

Good question

	Weak cartilages need reinforcement in the form of grafts and structural sutures to give the nose shape and bend the skin but also to resist the forces of scar tissue contracture over many years.  Very strong cartilages arent great either unless they are perfectly shaped and if youre going through a rhinoplasty, chances are your cartilages are not perfectly shaped.  Medium strength cartilages are best just like medium thickness skin is best but we rarely find a best case scenario in thousands of patients who come for rhinoplasty.

Harrison C. Putman III, MD (retired) · Answer

Weak nasal tip cartilages can be diagnosed before surgery by careful examination. This condition predisposes to functional and aesthetic problems post operatively due to contraction and loss of support if not addressed with supportive measures, including structural grafting and sutures during surgery. These measures do not necessarily create deformity, but can actually enhance the long term results. Careful planning with an experienced surgeon is needed.

What Are the Implications of Having Weak Nasal Cartilage in Rhinoplasty?

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