When do you need a graphs and/or a bridge with Rhinoplasty/septoplasty?

Question

I have had doctors who recommend it so that my nose doesn't fall or create problems in the future, and others who say they won't use it. Will I have long term effects if they don't use graphs and/or a bridge? Thank you!

Ronald J. Edelson, MD · Answer

Your question is a great one and requires some perspective. I’ve been doing rhinoplasties well over thirty years. When I started  everyone did a basic closed rhinoplasty rarely with a graft and got great results. Then in 80s and beyond there was a switch to open rhinoplasties. As time went on surgeons started placing cartilage grafts here and there with very little thought about it’s purpose. They were just doing what they were taught. Now the absolute urge to place grafts is universal and really overboard if you ask me. They get nice results but so do I and I virtually never use a graft, the problem with  grafts is that they leave the nose overly large and can make iI feel hard or stiff. Also the more grafts you use the greater the probability that one or more grafts will have a problem. The “ urge to graft” has made nasal surgery far more complicated and harder to learn. I see many patients who had cartilage grafts that are either too large or shift position when most didn’t need to the graft to begin with. Cartilage grafts have their place in rhinoplasty and good results can be obtained often using grafts or not. An overall assessment of the surgeons experience and results is a far more important criteria when selecting a surgeon.

Gerald Minniti, MD, FACS · Answer

Structural rhinoplasty calls for grafts in all patients, regardless of their appearance (as suggested by one surgeon answering your question). Any time surgical manipulation has occurred anywhere in your nose (tip or bridge), supporting ligaments have been severed and/or the cartilaginous structures have been destabilized due to reduction or repositioning. Grafts are very important in long term results and predictability. Grafts are usually obtained from the septum inside your nose for a primary rhinoplasty.

Evan Ransom, MD, FACS · Answer

Thank you for the great question. Based on your description, I imagine you are describing spreader grafts. These are long, thin pieces of cartilage placed along the top of the septum under the nasal bridge to provide support for the middle third of the nose and prevent sagging/collapse here. This type of graft is not essential in every case, so without examining your nose, I can't say if it would be right for you or not. In general, patients with weaker cartilage or shorter nasal bones require this type of support. It is also needed when a larger bump is removed. Best of luck moving forward!

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. I think rhinoplasty is one of the most beautifying surgeries that we do as plastic surgeons. Whether to use grafts or not is totally dependent on your individual anatomy. That is the beauty of doing noses, no two are the same. It is important to only see plastic surgeons with extensive experience in rhinoplasty, ie perform at least 6 per month and have performed hundreds of cases. Also, critically evaluate their on-line galleries to see if their art form resonates with yours. Rhinoplasty is definitely a grey haired plastic surgeon's sport. Best wishes to you.

Toby Mayer, MD · Answer

It is impossible to tell you what you need without photos and what is needed for YOUR NOSE. You need a consultation with a very experienced rhinoplasty surgeon. Look for natural results.

Matthew Bridges, MD, FACS · Answer

You can't lump all grafts together.  They are used for a variety of purposes in rhinoplasty.  It depends on what your nose looks like, whether you've had surgery before, etc.  I don't know what you by "need a bridge". Do you mean grafts on the bridge?  When you have a rhinoplasty, you don't choose whether you want grafts or not.  Leave it up to the surgeon.  That's like telling an artist what brush to use.  I know this sounds arrogant, but rhinoplasty is incredibly complex and difficult. It takes many years to master. You should explain to your surgeon exactly what you want to accomplish with rhinoplasty, then let him/her decide how to do the surgery.

Steve Laverson, MD, FACS · Answer

There are multiple indications for incorporation of grafts in rhinoplasty, and multiple types of grafts available, each with its own characteristic risk and benefit profile.

You should ask your surgeon why or why not use grafts to better understand the rationale and to decide for yourself what technique to believe is best for you.

Seung Il Ha, MD · Answer

Hello!That would depend on what procedure exactly you will have (rhinoplasty can include different approaches). If you only have a septoplasty, no, you won't need to support the tip, but in you have also a tip plasty, then in order to make it higher you would need cartilage grafting. 
Dr. Ha, Seoul Queen PS, South Korea

Robert Singer, MD · Answer

Grapfts are certainly beneficial in the appropriate patient when done judiciously and placed artistically.
Every nose is different and unique to that individual.  What would be the best option and exact procedure would depend on an examination and discussion about desired outcome. Excellent results can be achieved with either a closed or open technique.
Keep in mind that following advice from a surgeon on this or any other website who proposes to tell you exactly what to do  without examining you, physically feeling your tissue, assessing your desired outcome, taking a full medical history and discussing the pros and cons of the operative procedure would not be in your best interest. Natural appearing results need to be individualized and what is appropriate for one patient is not necessarily the best for someone else. I would suggest that you find a surgeon with extensive rhinoplasty experience certified by the American Board of Plastic Surgery and one who is ideally a member of The American Society for Aesthetic Plastic Surgery (ASAPS).

Robert Singer, M.D., FACS

La Jolla, California

William Portuese, MD · Answer

Grafts are not needed for a septoplasty, that usually  Involves removal of crooked bone and cartilage in the back of the nose.  A full set of facial photographs are going to be required to make a determination about use of cartilage grafting for rhinoplasty.  The most common graft that we use in our practice are spreader grafts that are inserted underneath concave upper lateral cartilages after the dorsal hump removal to prevent collapse in the mid vault portion of the nose.

When do you need a graphs and/or a bridge with Rhinoplasty/septoplasty?

Answers (11)

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