Cartilage Grafts
November 19, 2014Cartilage Grafts: Quality and Source
Cartilage grafts are often used in cosmetic, reconstructive and — even more often — revision rhinoplasty procedures. These grafts may be necessary to: provide structure or support to various nasal structures; add volume and shape to the tip; rebuild “collapsed” areas from previous rhinoplasty procedures; correct nostrils that are too wide (alar base reduction); or reduce a bump. Cartilage grafts are also often used in procedures to fix a broken nose and in functional rhinoplasty procedures (to improve breathing).
Why Are Cartilage Grafts Necessary?
Cartilage grafts are an extremely important tool in rhinoplasty procedures. Without them, many patients would not be able to achieve positive cosmetic results from rhinoplasty.
While it is preferable to reshape the nose without the need for grafts, in many cases this is not possible because there is not enough support or tissue. This is often the case in revision rhinoplasty procedures, for example, where removing further tissue would only worsen the existing deformity.
It is also common in patients in need of increased tip projection; that is, an increase in the distance between the front portion of the tip and the base. This is very important because tip projection is one of the most important aspects of an attractive nose. Without proper projection, the nose may have a thick, full or heavy appearance.
In these and other situations, it is often necessary to use cartilage grafts to achieve optimal support and structure.
Where Are Cartilage Grafts Taken From?
Cartilage grafts may be taken from the patient’s septum (septal cartilage) if there is enough available, from the ear (conchal cartilage) or rib (costal cartilage).
Which Is The Most Preferred Source? Why?
The preferred source depends on what the surgeon is trying to accomplish, but in most cases it is preferable to use the patient’s own cartilage, because it is more likely to be well tolerated by the body.
The patient’s own septal cartilage is often the best choice. However, in many revision rhinoplasty procedures it is not available due to the fact that it was already harvested in previous rhinoplasty procedures. For this reason, a surgeon may turn to ear cartilage, but ear cartilage is not as strong, so in many cases it is not a viable option. In these cases — particularly cases in which the nasal tip needs support — the preferred source may be irradiated cartilage from a cadaver.
Sometimes, a synthetic graft called medpor may be used for support and definition.
Some surgeons believe that all of the aforementioned grafts are preferable to rib cartilage grafts, because harvesting these grafts can cause scarring and potential damage to the lungs and pleura; there is also a risk that they may dissolve.
Most surgeons do not consider silicone grafts a good option.
