Rib and Fascia Vs Ear Cartilage to Fix a Scoop

What is the "Best" option for augmenting the nose?

You will not get agreement amongst surgeons to this question! With that caveat out of the way, I'll give you the opinion that I've held for more than 5 years: Diced Cartilage (your own cartilage) Wrapped in Fascia (your own fascia) is "the best" tissue or material available when a significant augmentation of the back of the nose is needed.

Advantages of Diced-Cartilage Grafts Wrapped in Fascia:


It becomes completely integrated into your body, therefore it will not have a risk of becoming encapsulated or infected in the future like an implant can.

When your own cartilage and fascia are used (instead of cadaver tissue), the chances of resorption of the tissue is the very lowest.

Because the cartilage is diced into tiny pieces and wrapped in a soft wrapper of fascia, it is the least likely graft to have it's edges become visible through the skin over time as our tissue age and our skin thins.

This graft technique is "mold-able" to a small degree even at one week after surgery, where minor adjustments can simply molded through the skin and your splint can then be replaced to protect the nose during healing for the 2nd week.


Some Disadvantages:


Probably the biggest disadvantage is time. It takes time to harvest fascia using a small incision behind the ear and time harvest and prepare the cartilage (which can come from either the nose, ear or rib).

It is not rigid enough for cases where a very large augmentation of the nose is needed.


Hope this helps!

Nick Slenkovich, MD FACS

 

using your own - not irradiated cartilage - is your best choice since it is structurally sound and will not reabsorb.

diced cartilage and fascia is a good option but it lacks any support if your nose needs to be lengthened

I read your concerns. If you have trouble breathing through your nose, you may indeed require Revision Rhinoplasty Surgery. If your breathing is not an issue, you would be surprised how much improvement you could see in the appearance of your nose after a well-performed Injectable Filler treatment. My personal preference is to use Silikon-1000, an off-label filler for permanent results.

Regards from West Orange.

Using ear cartilage or rib may be equally effective in correcting your nasal concerns.  Different surgeons have different preferences regarding their choice of donor material.  Some surgeons would argue that using your own rib is better than cadaver rib as well.  The important question is how much cartilage is needed and is ear going to provide enough grafting material as well as how experienced your surgeon is in performing a complicated revision procedure. 

Septal, ear and rib cartilage are all good sources of cartilage. Depending on the specific use some times may be better than others given their size and strength.

Some surgeons like to use a diced cartialge wrapped in fascia technique for augmenting the dorsum. I prefer using a patient's own cartilage that I then carve.

Fixing an upturned tip often requires strong, straight cartilage. The septum or ear are usually the best sources of cartilage for this purpose.