I recently had a revision surgery to build back my bridge, which was overly reduced in the primary. The surgeon used cadaver bone. Now that bone is quite visible and projects out. The two remedies to the problem are: A) go back to the surgeon and remove the bone graft, or B) see a surgeon to use another grafting material, such as rib cartilage. I don't know how the carilage graft would work. My concern would be that I end up in a situation where I have that noticeable graft on my bridge again
How Does The Process Of Using Cartilage To Build Up a Bridge Work?
Doctor Answers 6
How do you build up the nasal bridge?
I vote, none of the above. IMHO, rib bone, rib cartilage, bone, irradiated cartilage/bone and conchal (ear cartilage) all have been shown to dissolve unevenly over years and as such, I do not use any of these materilas for building up the nasal bridge and haven't done so for over 20 years. Instead, I prefer to use the straight (not L-shaped) dorsal silicone nasal implant. It's reliable and won't ever dissolve. Photos would help in the evaluation but a closed Revision Rhinoplasty to remove the evisting rib bone and replace it with the silastic graft.
Nose bridge requires rebuilding and reshaping
First off, any dead material (cadaver bone or rib) is not a reliable choice. There really is no reason in 2011 to choose something dead when there is living tissue (ie: rib, ear, and septal cartilage) available for use. The alternatives are diced cartilage grafts wrapped in fascia (material that covers the temple muscle) or surgicell, rib graft (diced or shaved down), ear cartilage (diced or shaped; preferably diced and molded), as well as silicone implants. Your surgeon should be adept at all these techniques or you should find one that is. When you find the right surgeon, you will know it. Do a thorough search and don't rush. View before after images and an expert in rhinoplasty would have all the above techniques in his/her toolbox to use and help you attain the nose shape you desire.
How cartilage is used to build up bridge
I typically use cartilage to rebuild the bridge in cases like yours. It sounds like you problem may be more of one of the shape and coverage of your bone graft. The bone may be able to be reshaped and/or covered with fascia.
An alternative would be to remove the bone and replace it with cartilage. Depending on your specific requirements this could involve septal, ear or rib cartilage. Septal or ear cartilage may have to be layered to give the height requirements you need. Rib cartilage is usually carved as a solid block into the shape needed.
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Building up your bridge.
If you submitted photos I could be more helpful. Basically you'll need to put something in to build things back up. Today, there are a variety of materials available and even injectibles can be used. Cadaver grafts have the advantage of not needing to be taken from you, causing another donor site. There are additional choices, some of which are synthetic and have some advantages as well.
Cartilage to Build Up Nasal Bridge
For over 30 years I have used the patient's own cartilage taken from the septum, ear. or rib to augment the nasal bridge.Although I prefer cartilage, It sounds like your problem is not the material used, but the amount and contour of the cadaver bone. The graft can be reduced and/or covered with fascia.
Build up the bridge
If the problem is that the augmentation is too high, then all you have to do is have your surgeon shave it down. This can happen with any graft or implant if you and the surgeon are not on the same page regarding how hig you want your bridge to be. If the problem is skin contracture showing the edges of the graft then again it might be helped by smoothing or fascia wrapping. Depending on how much height you want the diced catilage wrapped in fascia technique can give a smooth augmentation of a couple of mm if structural support is not needed. Synthetc implants are precise in size and smooth but always carry the risk of infection/displacement which could require further surgery.
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