How long-lasting is diced cartilage wrapped in fascia for building the nasal bridge?

Question

There seems to be conflicting opinions online regarding the longevity of the diced cartilage wrapped in fascia technique for augmenting the nasal bridge. I know that DCF minimizes the risk of warpping, but how easily does the graft resorb over a long period of time? If it does, is it difficult to take it out for a revision rhinoplasty?

Garrett Griffin, MD · Answer

DCF has only been around for about 10 years so I think it is a little difficult to know for sure how long it lasts.  That said, there is no reason it shouldn't be permanent.  Other grafts of fascia and/or cartilage in the nose are permanent and so there is no reason to think the DCF will absorb over time. Certainly the swelling takes 12 even 18 months to completely resolve but after that point the result should be permanent.

Mark K. Markarian, MD, MSPH, FACS · Answer

Hello and thank you for your very informed question.  First off, it is obvious that you have done your research and are asking good questions.  I commend you for that.  One of the beautiful things about plastic surgery is that it is a constantly evolving field, and rhinoplasty is not an exception.  Research and clinical studies (with at least 10 years of follow up) in cartilage grafting with fascia, has shown it to be a safe, reliable, and predictable method of dorsal augmentation in rhinoplasty.  Cartilage can be diced, placed in strips, or can be placed in different ways, based on the experience of the plastic surgeon in combination with fascia for dorsal augmentation.  Because there are so many different methods to augment the nose, whether its using your own cartilage, cadaver cartilage, or different types of fascia, no one method is universally better because it depends on so many factors such as the patient's cartilage quality, the complexity of the nose anatomy, any history of trauma or nasal surgery the patient may have had, and the postoperative care the patient takes.  Moreover, since different surgeons have different preferences, the results inevitably depend on the surgeon who is performing your rhinoplasty.  In my hands, diced cartilage with temporalis fascia can be precisely placed in the dorsum of your nose for augmentation with no significant risk of malposition.
The next step for you is
to find the right aesthetic plastic surgeon.  In your rhinoplasty
consultation, be sure your surgeon addresses all your aesthetic goals and concerns
specifically, and discusses the surgery details including the position and size
of the incisions used (with actual photographs and not just digital animations),
the risks and benefits of the procedure, recovery time, and post-operative
course.  Also, be sure to see plenty of before-and-after pictures in women
who have a similar nose appearance to yours, and preferably at different time
frames (3 weeks out, 3 months out, etc) to more accurately predict your own
surgical outcome.
And lastly, I think the most
important component of the consultation is to establish a good connection with
your plastic surgeon.  It’s the connection that allows you to clearly define your desired nose outcome
goals, the first step of this whole process. If you don’t feel you have a
good connection with your plastic surgeon after your consultation, he/she may
not be the best surgeon for you.

Good luck.

Mark K Markarian, MD, MSPH

Harvard-trained Board Certified Aesthetic Plastic Surgeon

Waleed Ezzat, MD, FACS · Answer

Thank you for your question. Actually, the use of diced cartilage wrapped in temporalis fascia is the most reliable methods of dorsal augmentation. This is also true of using temporalis Fascia or cartilage alone.  While there are other methods that can be used, autologous grafting ( using your own tissue versus an implant) has been shown through histological studies to retain a healthier cellular structure after healing. In my practice, I mainly use the patient’s own tissue and a few times, have used cadaveric cartilage.Hope this helps!Dr. E

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  Diced cartilage wrapped in fascia is my preferred technique for dorsal augmentation because it does not have risk of warping or malposition when good technique is used.  DCF has good longevity and should not resorb over time.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Barry L. Eppley, MD, DMD · Answer

Besides completely avoiding the issue of solid rib graft warpin for dorsal augmentation, the retention of diced cartilage grafts to the nose has been consistently very favorable. All such published studies show very good graft retention and that has been my experience as well. While the rib cartilage may go in as a particulate grafts it consolidates quickly and does no pose a problem secondarily of being able to be modified or removed. The interesting biology of cartilage grafting to the nose is that the graft is really quite inert due to its lack of cellularity and this gives it some features like an implant, acting more like an 'auto implant' of sorts.

Brad M. Gandolfi, MD · Answer

All techniques have there pros and cons, otherwise everyone would use the same technique! That said, I attend meetings each year with international faculty and the vast majority of the world's experts agree that diced cartilage provides superior results for augmentation of the nose. Silicone or goretex implants can extrude (come out) or become infected or move, and onlay cartilage grafts can warp and provide a harsh look. Diced cartilage forms basically a thick sheet of scarred fascia that lays above your current cartilage. 
Could the graft resorb? Sure, especially if a small infection happens, but it is rare. The benefits of this technique outweigh the potential downsides.

How long-lasting is diced cartilage wrapped in fascia for building the nasal bridge?

Answers (6)

More Rhinoplasty Questions

Can they put my nose back in place without surgery, even if it happened years ago? (Photo)

25 days post op Rhinoplasty-Pulled a stitch. Did I damage anything?

How much does it cost getting a bulbous nose job with all fees included done?

Infected stitches after rhinoplasty? (Photo)

WE SEND PRETTY
EMAILS