Concealment of Grafts --- Ear Perichondrium and Rib Perichondrium Layered

Question

I will be undergoing a complex revision rhinoplasty that which will entail the use of costal cartilage to augment the dorsum and radix. I need about 3mm of height added back to my bridge. My prospective surgeon and I are in the process of negotiation on how to combat the issue of my thin-skin. This will be my second rhinoplasty and I want it to be my last. Can ear perichondrium be used on top of rib perichondrium as an added layer of concealment of grafts? What would be the duration of swelling?

Richard Mark Winters, MD · Answer

Revision rhinoplasty is definitely one of the more complicated of all cosmetic surgeries ....Modern techniques take anatomy and structural relationships into account significantly beyond the destructive techniques of the past....a true rhinoplasty expert should be someone with requisite training/qualifications, a practice dedicated to rhinoplasty, many years of experience and a predilection to take on difficult cases/revisions....revisions certainly can take a bit longer to settle down and become refined....much of this has to do with the quality of the skin cover, degree of scarring/contraction, the damage rendered by destructive techniques from prior rhinoplasty(ies)....and the need for structural and soft tissue graftingMy personal approach has evolved into a 'best available' when it comes to donor grafting materials.....after years of performing revision rhinoplasties, I have become convinced that in order to achieve the very best results, I choose the best tissue for the job....often this results in the use of multiple donor sites (ear cartilage for tip structures, rib cartilage for dorsal structures, abdominal wall/temporal fascia for 'blanket' coverage, etc.) in a single rhinoplasty ...regardless of the degree of difficulty, revision rhinoplasty in particular requires a 'complete' approach in terms of restoring structures/relationships that have been compromised and obtaining a result that is desirable...Good luck....

Holger Gassner, MD, FACS · Answer

Hi,
the choice of the right transplant material for camouflage is important. Often, the surgeon decides during the case which material is best suited. Options inlcude thin fascia from the temporalis muscle or from other sources, perichondrium, diced cartilage and many more. I would advise not to get too involved in your surgeons´s decision. Key is you have confidence and trust she / he will make the right choice at the time of surgery. Best regards, Holger Gassner, MD, Regensburg, Germany

Concealment of Grafts --- Ear Perichondrium and Rib Perichondrium Layered

Answers (2)

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