Are Grafts Needed in Primary Rhinoplasty?

Most patients undergoing primary rhinoplasty in my opinion do not need grafts especially when taking down a nasal hump if other structures that support the nose are left intact or reconstituted. However, the use of grafts depends upon what the problem is. If you have ample tissue in your septum, then removing a portion from that part of  your nose and placing it on another part of your nose for tip support or to prevent a breathing problem is often helpful and very safe. You might want to get another opinion to see if grafting is really necessary in your case or ask your surgeon specific reasons why he wants to place grafts and what types they are. I hope this information helps.

Most surgeons use some graft during a primary rhinoplasty, as I do often.  Grafts are placed in different locations and used for different reasons.

There are spreader grafts, tip grafts, alar grafts, columellar grafts and more.

Good luck.

The grafts are often used and come from your septum. There are no concerns with doing this if the surgeon routinely does this. Often when the bump is removed I use spreader grafts to make the nose look and breathe better.

It is impossible to know for sure whether or not you will need grafts as part of your rhinoplasty without an exam.  The areas we would commonly use grafts are to either support the tip, augment or refine the tip, or improve the airway.  The decision really depends on your examination and in truth also your surgeon-- some use them commonly in primary rhinoplasties, others rarely do.  That being said, either approach can create a very nice result, so in the end it really depends on your surgeon, his experience, and your comfort level with his plan.

We perform cartilage grafts such as spreader grafts in many of our rhinoplasty patients. Not all patients need cartilage grafting. If you have a long, thin nose that is susceptible to collapse or is very pinched and narrow preoperatively, yes indeed you will need spreader grafts placed at the time of the surgery. If they are placed in an appropriate fashion, you should never even feel them or notice that they are there, but if you simply have good strong wide cartilages and just simply require a bump removal, some tip work, and osteotomies, then you will not need any cartilage grafts.

Cartilage grafts are fairly routine in rhinoplasty and nothing to be concerned about if needed (assuming that it isn't being taken from the rib or ear, which is much less common for a first-time surgery).  When you take down a larger bump, you have to be very careful with the middle third of the nose - this is the most critical area regarding breathing. Adding cartilage to this area helps to maintain a sufficient opening to prevent a breathing problem from developing. If needed, this absolutely should be done. A patient would likely never know if a graft was harvested from the nose and shouldn't be something you worry too much about. You will absolutely notice if you needed grafts and no grafts were placed - every time you breathe in.

The most important functional or breathing part of the nose is in its middle third in an area we refer to as THE NASAL VALVE. The area is a triangle divided into two by the upper septum and the central/upper portions of the upper lateral cartilages. We can roughly estimate the breathing importance of an area of the back of the nose we are considering removing by gently pinching the area we may be removing and see how it affects breathing.

When a nasal hump is removed, we remove portions of the septum, upper lateral cartilages and nasal bones. When the remaining side walls are brought together the area of the nasal valve is narrowed and MAY compromise breathing. This can be prevented by putting invisible narrow grafts between the septum and the top portion of the upper lateral cartilages on either side. These SPREADER GRAFTS will open up the angle, making breathing easier but , depending on how forward they are placed, can also straighten a curved, deviated septum as well as suspend a nasal tip or lengthen a nose.

I would NOT shy away from having them IF the alternative is compromised breathing after the hump removal.

Without seeing pictures or examining you I cannot tell you if I would use grafts. Grafts, which are usually cartilage taken from the septum or ears, are frequently used in primary rhinoplasties to improve appearance or breathing. Look at the results of these surgeons in  patients similar to you, both with and without grafts. Selecting your surgeon is worth the time and effort it takes.

Cartelage grafts of some kind are now almost routiene in primary rhinoplasty. We use them to support or refine the structures left, fill in areas so we do not have to over resect other areas, and to improve breathing. They are generally different in each case, depending on your particular problem.