What grafts can be used to replace missing lateral crura and which graft material would be best?

My PS removed over half of my lateral crura and I now have a severely pinched nasal tip and collapse on either side. I don't believe regular batten or lateral crural strut grafts would be sufficient in my case, since so much cartilage was removed. My PS saves all of his patients cartilage in case they were to get in a car accident or something, so could this cartilage be used to rebuild my nose? Also, can grafts be made to replace the entire lateral crura? Thanks!

Doctor Answers 6

Lateral Crura Strut Grafts and Alar Batten Grafts in Pinched Nose

I typically rely on the lateral crural strut graft technique when too much native cartilage has been resected. Strut grafts are placed under the remaining native cartilage (underlay) and often possess a mechanical advantage over the alar batten graft, which is placed on top of the native cartilage (overlay).  However, both types of grafts can be used to correct pinching and collapse, especially when they are made to overlap onto the maxillary bone or pyriform aperture. The choice of underlay or overlay graft, as well as the size of the graft, depends on anatomic need and the preference of the surgeon. If available, I prefer septal cartilage because it is strong yet thin, and not prone to warping.  Secondary choices include rib cartilage and ear cartilage. Ear cartilage can be weak and fragile, while rib cartilage becomes calcified in older patients and is prone to warping. Best wishes. 

Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 96 reviews

Which cartilage is best for post operative pinched nasal tip

Autologous septal or rib cartilage is alway best for lateral crural replacement.
Properly screened and preserved homografts can also be used, good luck.

Somyos Kunachak, MD
Thailand Facial Plastic Surgeon
4.8 out of 5 stars 16 reviews

Cartilage grafts

The best cartilage would be septal or rib cartilage. Best of luck with your decision to move forward with your surgery.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Reconstructing lateral crura

In my experience, the best cartilage for this is either the nasal septum (if it is thick enough) or rib cartilage. Rib cartilage is much stronger, can be shaped and carved to suit the purpose and is accepted very well in the nose. You should only see a surgeon who has extensive experience in revision/reconstruction rhinoplasty as this type of procedure is complex.

Revision rhinoplasty for pinched tip etc.

A revision rhinoplasty can be done to correct your pinched tip For 35 years I have used both batten graftss and full cartilage replacement of lateral course.  See a very experienced revision rhinoplasty surgeon for this.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 32 reviews

Grafting material

It sounds like your lateral crura were over-resected and now there is a lack of support to the nasal tip. Even if you have just a small amount of lateral crura present, placing a lateral crural strut graft is the most appropriate treatment to restore the strength and support to this region. The areas that cartilage can be harvested are septum, ear, or costal rib cartilage. Where the cartilage is harvested from will depend on if you have sufficient septal cartilage present. If not, the other sites will have to be considered. Hope this helps. Best of luck. 

Michael T. Somenek, MD
Washington DC Facial Plastic Surgeon
5.0 out of 5 stars 29 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.