Can tip grafts be replaced with bioresorbsble grafts?

Question

SEGs are often used to support the nosetip and resist possible scar tissue changes or other factors. PDS or other slowly, strong absorbable materials could support the nosetip until the nose is healed and the scar tissue has setled. After bioresorbtion, the resulting structure should be more pliable than the cartilage graft, yet offer enough support, especially if the tip cartilages are intact. Would a strategy like this be possible to remove grafts and get a soft and flexible tip?

Mark K. Markarian, MD, MSPH, FACS · Answer

Hello and thank you for your question. I will try to answer your question in the best possible fashion without photographs and an exam in person. Nasal support, and especially tip support, in rhinoplasty is a key component in optimizing long-term results. Always remember, cartilage grows throughout your whole life, so your nose can grow (and shift) in time. Sturdy cartilage support is key to facilitate long-term results. Cartilage grafts are similar to scaffolding on a building to reinforce the modifications made. In your question, you refer to soft, pliable support structures. In my practice, I utilize extended spreader grafts (instead of a septal extension graft, SEG) and lock these into a columellar strut. This streamlines the nose, supporting the dorsal aesthetic lines, and also facilitates nose and tip support to reduce the risk of crookedness, and tip rotation (or under-rotation). I also complement these techniques with a nasal tip deprojection locked into the tip complex for further support -- tip deprojection reduces the length of the lower lateral cartilages, and thus reduces the torque and tension, providing further stability. Ideally, the nasal tip should be sturdy (and not soft and flexible) to optimize long-term results...

Hope this answer helps. I recognize this is a general response and would recommend that you seek an in-person consultation with a board certified plastic surgeon to have a more tailored evaluation and response to your specific situation. Good luck and please let me know if I can help.

Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Aesthetic Plastic Surgeon

Hope this answer helps.  I recognize this is a general response and would recommend that you seek an in-person consultation with a board certified plastic surgeon to have a more tailored evaluation and response to your specific situation.  Good luck and please let me know if I can help.

Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Aesthetic Plastic Surgeon

Can tip grafts be replaced with bioresorbsble grafts?

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