Which of these is the best source of cartilage graft to support and rebuild a columella and infratip lobule?

Hi there, this is a great question: which cartilage is the best for grafting in rhinoplasty? In your case you are looking at the columella and the infratip lobule.The options include the septum, the ear, your own rib, donated rib, and also alloplastic materials (artificial tissues).If good quality septum is available it is probably every surgeon's favorite material (ok maybe I should speak for all surgeons, but the majority). It is strong and straight and easy to carve. Unfortunately septal cartilage might not be in good shape is there was trauma, an infection, or if it was already harvested during prior surgery.Ear cartilage can be a really good option because it is easy to get and minimally affects the shape of the ear (it can flatten a little sometimes). The difficulties are getting enough material for what you want (hard to get a piece you can put over the bridge to augment) and that is has a curve to it. But it can be straightened to use it in the columella.Using your own rib you get plenty of cartilage to use. It might be necessary to be albe to reshape and support the nose. It does add an incision in your chest and the recovery can be a little more painful (initially after surgery when you breath in and out the chest will ache). There is also a risk of a small puncture of the covering of the lung, that risk is really small and if it happens your surgeon is usually able to close the hole during surgery. Rib cartilage is best under 40 years of age, afterwards it starts calcifying and it is harder to shape. If you put a long straight piece of cartilage, there is a risk of the cartilage twisting months afternoon the surgery. This is called warping and it happens as the rib returns to its original shape which is slightly curved in the chest. Your surgeon will use techniques to prevent this, but on occasion this might still happen. Some doctors also have access to donated rib cartilage which is irradiated. There is some debate about how irradiated compares to native, but in general I think irradiated is just as good if you are getting the right product.The last option is using alloplastic material. Common one is gortex and medpore. I would advise you against it in the columella, it can often get infected and exposed in that location.Hope this information helps you make a decision. Good luck!

Nasal septal cartilage is always the best source of cartilage grafting material for reconstructive revision rhinoplasty.  If there is a cartilage depleted nose from a previous septoplasty, consider ear cartilage if needed.  Synthetic materials and rib cartilage are also alternatives,  but each one of them has their own advantages and disadvantages.

Rhinoplasty is a surgery to improve the shape of the nose for breathing or appearance.Surgeons use cartilage grafts to create structure and shape. The cartilage may come from the nose (septal), ear (auricular), or rib (costal). Here are the advantages and disadvantages of each.Septal cartilage is a single site surgery, no warping, good support without making the nose too stiff. There is a limited amount of cartilage, especially if it has been damaged by trauma, drugs, or infection. Harvesting too much septal cartilage can affect the stability of the nose.Auricular cartilage is great for curved grafts, but not for support. The is a low risk of warping. It's thicker/bulkier, requiring a 2nd or even 3rd (two ears) surgery site. Costal cartilage is great for long, strong, thin grafts. It's abundant. Harvesting and carving is a more advanced surgical skill. It will make the nose stiffer. There is a risk of warping and it requires a second surgery site. Even if the chances are low, I like to discuss the potential to use cartilage from any of these sources in every patient so I can perform a complete surgery, instead of compromising one area of the nose for the other. Safety comes first. 

The cartilage from the septum, ears, or ribs can be used to augment the columella. Choice ill depend on availability and your needs but my preference is the sequence mentioned because of the ease of harvesting in each location.