Ear Cartilage (DCF) or Silicone Implant for Asian Rhinoplasty? (Photo)

Hello and thank you for your question and your photo. While it is difficult to provide a specific recommendation based on a single image, I can tell you that both synthetic implants and cartilage grafts each have their own pros and cons. The choice of material should be personalised to the unique needs of each patient and the preferences of the surgeon performing the rhinoplasty. The second surgeon you met with is referring to a relatively new technique in rhinoplasty that involves dicing the cartilage and wrapping it in fascia, which is supposed to provide a smooth, natural result. Rather than choosing your procedure based on the material used or whether the surgery will be performed in an open or closed fashion, select a surgeon who has the experience, training and credentials to provide you with the best possible experience and results. Best of luck to you on your upcoming surgery!- Andrew L. Greensmith, MBChB, FRACS

Dear Sanawm,Thank you for your question. From the photo you provided you have a nasal hump that would need to be reduced to give a nice and natural aesthetic line. Placement of a silicone 1.5 mm implant will only make the whole nasal bride higher. Infections are not related to thickness, they are related to biologic contamination and resulting biofilm formation (1.5 mm implants can become infected as well, but there is a lower chance of extrusion/breaking through the skin). If cartilage is prepped and placed in appropriate fashion, there will be no bumpiness. Further, if the cartilage is prepped appropriately and wrapped in fascia, then there is no reason to have fat from the stomach placed.  Further, stomach fat, compared to other sites, can grow in dimension if you gain weight, hence, harvesting from a less metabolically labile site is better than from the stomach. Finally, an closed or open approach are viable and both can create an excellent result. I hope this helps you find the right answer for you.Be healthy and be well,James M. Ridgway, M.D., FACS

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 an Asian rhinoplasty specialist. 

 The Limited photograph demonstrates a large dorsal hump which  Needs to be removed, therefore no graft/ implant should be necessary whatsoever for the bridge line. DCF and silicone will not be required. A closed rhinoplasty approach can accomplish all the required changes to the nose with all the incisions placed on the inside of it.

Hi,In your case, you probably have enough septal cartilage to augment your bridge by 1.5mm. Silicone is also a good option but I would put that in with an open approach because I believe its more acurrate and is a safer way of putting a silicone implant as far as sterility goes. Best, Dr.S.