When is synthetic a better option for rhinoplasty? Is this only an option when natural cartilage failed on the first surgery and you need a revision, or vise-versa? What are some likely scenarios?
When is It Best to Use Your Own Cartilage for Rhinoplasty?
Doctor Answers 16
It is best to use your own cartilage if possible
It is always better to use your own cartilage if possible because it provides a lower risk of infection and complication, higher rate of incorporation, and better adaptability. In revision cases, it is even more imperative as the blood supply may be compromised from the previous operation(s), and, as a result, synthetic material may have a higher potential for failure. In primary cases for Asian, Hispanic, and African-American patients, silicone may be acceptable for dorsum; however, I still prefer patient's own cartilage.
Natural cartilage grafts in rhinoplasty
Your own cartilage will always be a better choice to consider provided you have a good source for the grafts. Septal, ear or rib graft sources are the traditional areas to consider. There is less chance for infection or rejection when your own tissue is used for augmentation. Alloplastic grafts can be very beneficial when other choices are not available.
Cartilage grafts in rhinoplasty
It is always best to use one's own cartilages from the septum or ear. When not available then synthetic materials can be considered but again it should be a rare situation.
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What is the Best Grafting Material for Rhinoplasty?
It is best to use one's own cartilage for grafting in rhinoplasty surgery. Depending on the purpose of the graft, septal cartilage and ear cartilage are often successfully utilized. If these sources are unavailable or insufficient quantities available, then other options such as rib cartilage or synthetic material may be considered. The necessity of grafting during rhinoplasty and source of grafting material should be discussed at the time of consultation, after a nasal examination.
You have asked the very question that is so often discussed at plastic surgery meetings. The answer varries from doctor ot doctor and year to year. My feeling is to use autografts if possible but, you may not have enough septal cartilage to do this. If that is the case alloplasts are also a good choice
Synthetic implants for rhinoplasty
There is no absolute better or worse, just advantages and disadvantages to alloplast (implant) vs. autogenous tissue. Primarily, implants are quicker and easier to use, and do not require your surgeon to harvest donor cartilage from your nasal septum, ear, or rib. Implants however, may become exposed or infected over time, and require removal. Proper placement of the implant diminishes the possibility of exposure or infection. The use of RNA inhibiting peptide or a similarly functioning analog, I believe, will significantly diminish or eliminate implant related infection in the future (Balaban et al, Tufts University).
Rhinoplasty -- cartilage or synthetics.
I prefer ePTFE synthetic implants over septal cartilage for raising the nasal bridge during Rhinoplasty Surgery.
If the nasal bridge needs to be raised, and Rhinoplasty Surgery is necessary for tip refinenent, I typically prefer a synthetic ePTFE implant over cartilage. ePTFE implants may be custom carved in the OR, and my experience with this material has been favorable. Complications with ePTFE like infection, extrusion, or misplacement are uncommon and occur in less than 5% of patients. The majority of my patients withh ePTFE dorsal nasal implants are thrilled with their results.
Many reputable rhinoplasty surgeons prefer septal cartilage, ear cartilage or rib cartilage for dorsal augmentation. There are pros and cons with nearly every procedure, so you should discuss all of your options with your surgeon to see what might be best for you.
The ideal implant is always to use your own tissue. However, this is not always possible and not always desired by the patient based upon how the cartilage is harvested( i.e. rib)