Are grafts used in preservation rhinoplasty ?

Question

Hello, I was wondering if grafts are less used in preservation rhinoplasty compared to normal traditional rhinoplasty ?

Oakley Smith, MD, FRCSC · Answer

Hi, It is better for you to consult with your facial plastic surgeon who can examine you and give you opinion based on examination. Yes, they are less used in preservation technique.

Eric M. Joseph, MD · Answer

"Preservation rhinoplasty" is an alternative rhinoplasty technique for deprojecting the bridge of the nose.  If somebody requires correction of a droopy nasal tip, or if they have thick nasal skin, cartilage grafting to the tip may still be indicated. I hope this answers your question. Sincerely, Dr Joseph

Zeshaan Maan, MD · Answer

Preservation rhinoplasty can be partial or complete, and the choice is dependant on the nature of the patient's anatomy and their desired outcome. The possible components that can be preserved include the skin envelope, the dorsum, and the tip. In my practice, I aim for complete preservation, but adjust my approach on a personalized basis for my patients. 
1. Preserving the skin envelope means dissecting in the deepest plane right on top of the cartilage - this prevents thinning of the soft tissue and limits bruising and swelling. The impact on whether grafts are needed is minimal. 
2. Preserving the dorsum means not taking apart the normal cartilage and ligaments that make up the majority of the bridge of the nose, and lowering the bridge from underneath. This has a significant impact on the need for grafts, in particular spreader grafts. 
3. Preserving the tip means not excising any of the tip cartilage and relying primarily on suturing for shaping and positioning. However, even in a complete closed preservation, a columellar strut graft is not uncommon. 
So, in summary, yes preservation generally reduces the need for grafts, but they are still an excellent complement.

Ronald J. Edelson, MD · Answer

Overall I think surgeons do too
Many cartilage grafts which don’t do anything but can cause trouble later.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. When good technique is used, all types of rhinoplasty should involve structural support grafts. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Rajaie Hazboun, MD, MBA · Answer

Thank you for posting your question here!I will start by saying that dorsal preservation techniques have gained traction recently and are great if the patient is a good candidate for them. That being said for the most part the determination wether a patient needs a graft or not, is independent on wether you are using dorsal preservation or not . It is more linked to the patient's anatomy and complaints (ex: if the patient is having an internal valve collapse and need a spreader graft or not, or the need for a septal extension or strut graft which can be based on wether the patient needs to lengthen the nose or not or having a droopy tip that needs support or is over or under rotated), those are examples of some grafts but your surgeon will make the decision based on a plan that is tailored to your anatomy and complaints.I hope this helps, Best of luck!

Kailash Narasimhan, MD · Answer

That is an excellent question, I perform preservation in Rhinoplasty and over 60% of my patients. Yes, I believe that grafting is less common and less structural techniques are needed in the portion of the rhinoplasty in which preservation is performed. However, Grafton can still be done in other areas of the nose.

Kailash Narasimhan, MD
Narasimhanplasticsurgery.com
Tampa Bay plastic surgeon

Kailash Narasimhan, MD
Narasimhanplasticsurgery.com
Tampa Bay plastic surgeon

Sean Fisher, MD · Answer

It depends on the specific technique used and surgeon preference. Preservation rhinoplasty is a generalized term that can be used to describe a variety of techniques. The need for cartilage grafts depends on specific patient anatomy and what the goals of surgery are. In primary rhinoplasty, cartilage graft material can often be harvested from the septum and not require a second surgical site. Cartilage grafts can be very valuable in ensuring a long-term stable result, but should be used judiciously to avoid an unnecessary amount of excess cartilage material in the nose.

Mats Hagstrom, MD (license on probation) · Answer

My understanding of the term of preservation rhinoplasty is simply a marketing ploy.
Proper rhinoplasty surgery is based on making quality assessment and addressing the aspects of the nose that need changing in order to create a more enhanced nasal shape. Sometimes this involves removing tissue and sometimes it means adding tissue sometimes a combination of both.
What’s involved depends on what’s needed and what’s needed Depends on where we start and where we’re trying to go.
Best,
Mats Hagstrom MD

Are grafts used in preservation rhinoplasty ?

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