The Use of Cartilage Grafts in Primary and Revision Rhinoplasty
eyelid surgery (blepharoplasty) for a more youthful appearance

The Use of Cartilage Grafts in Primary and Revision Rhinoplasty

23 August 2021 Articles

The Use of Cartilage Grafts in Primary and Revision Rhinoplasty

Patients often express their concern about the use of cartilage grafts in rhinoplasty. The typical statement goes something like this: “I read on the internet where cartilage grafts can become visible and I was told they should be avoided.” True, while cartilage grafts can potentially become visible and unsightly, particularly in the patient with thin, transparent skin, that doesn’t mean cartilage grafts should be avoided.

To the contrary, cartilage grafting is an essential tool in both primary and revision rhinoplasty, and cartilage grafts of one type or another are used by virtually all accomplished rhinoplasty surgeons. In fact, in the lower nose, it is usually weak and droopy tip cartilage that makes a nose unattractive. Without the ability to strengthen and reshape the nasal tip framework, few if any such noses could be made more attractive.

The Use of Cartilage Grafts in Primary and Revision Rhinoplasty

The Use of Cartilage Grafts in Primary and Revision Rhinoplasty

 

Rebuilding the Nasal Framework with Donor Cartilage Grafts

Although reshaping the existing nasal cartilage is generally preferable, in many noses, there just isn’t enough natural strength or available tissue to do the job. This is particularly true in the previously operated nose, where much of the nasal skeleton is missing and the remaining tissue is often severely damaged. Because further tissue removal will only worsen the deformity, the outer nasal framework must be rebuilt with a mosaic of fabricated parts (grafts), carved from donor cartilage. This cartilage may be harvested from the septum (septal), ear (conchal) or rib (costal).

The new nasal framework is structurally engineered to insure that the desired shape is maintained faithfully over time; while the structure is also artistically designed for symmetry, proportion, and a contour that harmonizes with the surrounding features and lends beauty to the face. This form of “living sculpture” is virtually unique to cosmetic nasal surgery and requires a combination of artistry, experience and surgical ability.

Moreover, even when cartilage grafts are placed skillfully and secured properly, deformational forces such as wound contracture, skin fibrosis and cartilage warping can spoil an otherwise satisfactory outcome. Add to that the logistical challenges of nasal surgery, such as restricted visibility, bleeding, tissue swelling, etc., and the challenge becomes even more daunting.

Although cartilage grafting is far from easy, and often made more difficult by cartilage that is in poor condition or in short supply, in my opinion cartilage grafting is without question the single most important tool in contemporary rhinoplasty. Without it, only a small minority of patients could achieve satisfactory cosmetic results.