Diced septal or rib cartilage for minimal dorsal augmentation?
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Doctor Answers 9
Cartilage grafting to the nose is a very reliable technique in terms of volume retention. Its issues are in the shape obtained and any changes long-term. (e.g., warping) In a 'minimal' dorsal augmentation dicing the cartilage is not usually needed. This cartilage grafting technique is most appropriate for much larger dorsal augmentation.
Dorsal Onlay Grafting
Cartilage from the septum or rib is often used for grafting to the nose - either trimmed and beveled or diced - to provide varying amounts of dorsal augmentation. After implantation, over the course of 4-6 weeks, the grafts gradually scar into place - forming a more permanent attachment to the surrounding cartilage and bone.
Most of the cartilage survives, but some of it dies off or is replaced by scar tissue. Depending on how the grafts age with your nose, you may need a touch up with future surgery or fillers to maintain the result.
At this point, stem cell therapies are in their relative infancy. Currently, stem cell tissues are difficult to grow and are expensive to produce in large 3-D constructs. In comparison, septal cartilage is in copious supply and free. I would not, therefore, expect stem cells to supplant the use of septal cartilage for grafting in those patents where septal cartilage is available.
An alternative for you may be to use facial fillers (such as Juvederm) to provide dorsal augmentation without the need for surgery - especially if the augmentation is minimal. Fillers last a variable amount of time, however, a year is average.
Many of our patients travel from around NYC to the Albany / Saratoga Springs area to avoid the high costs of surgery in the city. An isolated dorsal onlay graft may cost $5500 including surgeon fee, anesthesia, and facility fee. Fillers would cost about $650.
See the link below for more info on the surgery, fillers, and pricing.
If there is adequate septal cartilage, and the defect is deep, more than one layer can be put together for a graft. The best piece is the top piece, with the edges beveled. They also can be lightly crushed to soften them, especially if the skin is thin.
If only non-septal cartilage is available, then the diced method will do.
These grafts are permanent or almost so.
Plastic surgery is not an exact science.
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Dorsal augmentation with your own cartilage is considered permanent but the nose continues to age and change and the shape of the cartilage implanted and the soft tissues will change over time. Stem cell technology will eventually allow us to create cartilage to use but will still need surgery to implant it in the proper place.
Cartilage grafts whether diced or not is often the best way to go for onlay grafts for the nose. Best of luck.
Hello and thank you for your question. Diced cartilage is the gold standard for dorsal augmentation. Make sure you specifically look at before and after
pictures of real patients who have had this surgery performed by your surgeon
and not just a computer animation system. 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.
Harvard-trained plastic surgeon
Nonsurgical rhinoplasty treatments may be considered for permanent dorsal nasal augmentation.
We do not have experience with diced cartilage for dorsal augmentation. Augmentation with rib cartilage is not an exact science and may lead to irregularities in some.
Depending on your examination, microdroplet Silikon-1000 may be considered for permanent dorsal augmentation. Feel free to re-ask your query with photos.
Hope this helps. Dr Joseph
Rhinoplasty - Diced Cartilage?
Tissue from your own body (autologous grafts) will give you a safer, more permanent result than synthetic implants. While en bloc cartilage grafts, especially from the rib, can warp over time, there are ways to eliminate this problem. Especially for dorsal augmentation (building up the bridge) using cartilage that is finely diced and wrapped in fascia taken from your scalp can be made into a custom size and shape for your particular nose (DCF). By dicing the cartilage the problem of warping is eliminated, and since it is tissue from your own body, it quickly becomes incorporated into your nose within 2-3 weeks. Results are certainly surgeon dependent, so it's important to do your research in finding a rhinoplasty specialist.
Diced cartilage can be used successfully for a permanent result that does not need any further procedures. I do think that there will be the possibility in the future to use the technology you described. The cost of the procedure depends on your geographic area and the factors that might make your rhinoplasty more or less complicated.