How is Cartilage Grafted for Use in Rhinoplasty?

The nose is one of the most complex features of the face. It’s shape and texture is due to a combination of skin, soft tissue, and cartilage. Altering the cartilage that gives the nose firmness and height is one of the main aspects of any rhinoplasty. In some cases, your surgeon may recommend that additional material be grafted onto your nose. Grafts during a rhinoplasty require a slightly more complex surgery, but they can provide very impressive and drastic results.

The Reason You May Need Cartilage Grafts

A cartilage graft is a small amount of material that is placed in the nose during a rhinoplasty. It helps to provide additional structure to an area. In many cases, a cartilage graft is necessary because a patient has already had one rhinoplasty. If the first rhinoplasty goes wrong, it can be helpful to get a cartilage graft. This will provide extra support in the area. Depending on the role in your rhinoplasty, you may end up getting one or more types of grafts.

Alar Batten grafts are a type of graft that is placed along the nasal sidewall to keep the nasal valves from collapsing. They can be very helpful for correcting noses that look pinched and make it difficult to breathe. Another method for making it easier to breathe are spreader grafts. These go along the middle of the nose, and they also tend to make the nose a little wider. If the tip of the nose requires more support and form, a doctor may do an onlay graft to project the dome of the nose or an umbrella graft to lift the tip.

Locations That Cartilage Grafts Are Taken From

The cartilage material used in a graft may come from a few different sources. In most cases, it is best to use the patient’s own cartilage because there is less of a risk of rejection. Ideally, doctors take the cartilage from the inside of the nose. Cartilage from the septum is very sturdy, can easily be removed during a rhinoplasty, and will not cause noticeable changes to appearance. If the patient does not have enough cartilage within their septum, the doctor can also take it from the ear and hide incisions and scarring within the crease of the ear.

Cartilage from other sources has a slightly higher risk of rejection, but it is necessary in cases where a patient does not have enough nose or ear cartilage for the procedure. It can be harvested from the rib region, though this typically is not done except for in cases of extreme reconstruction. Patients can also choose to opt for donor cartilage material. This typically comes from a cadaver supply. There are synthetic forms of the material that are used for grafting. Though the procedure of applying it is very similar, it is technically an implant, not a type of graft.

The Process of Grafting During a Rhinoplasty

After you consult your surgeon about your surgery, you will visit the doctor’s office on a schedule date. Most rhinoplasties are done under general anesthesia, so you will be asleep during the procedure. The doctor will start by making incisions along the interior or exterior of the nose. This will begin reshaping the underlying structure of the nose. Depending on the point of origin for your cartilage graft, the surgeon may also make other incisions to remove whats needed.

Once the graft is ready, it will be applied to the appropriate area. It will be supported with pins or small sutures. During the surgery, the doctor will also reshape the nasal region surrounding the graft to create a smooth and unified look. Once the new shape is refined, the surgeon will carefully re-apply the skin and stitch it into place.

Recovery With a Cartilage Graft

Once the surgery is over, your doctor will apply splints both inside and outside your nose. This will keep the graft in place while you heal. You will need to rest for the first twenty four hours after the surgery, and you will not be able to return to work for roughly a week or two. There will be a lot of swelling and bruising surrounding the region of the graft. Many patients find that this looks much worse than it actually feels. Recovery can take a little longer if you have a rib cartilage graft because there is more swelling in the nose and soreness in the chest. Depending on the type of rhinoplasty you have, it can take several months for swelling to go down and the full results to be visible.

Some patients worry that a cartilage graft might dissolve or warp over time. However, the type used in rhinoplasty grafts tends to be much sturdier than the rib cartilage. Most people do not need to worry about the cartilage moving or getting reabsorbed. If you are concerned about it, you should talk to your surgeon. An experienced plastic surgeon can take extra steps like precision suturing to make it easier for the graft to heal well.

Dr. Andrew Frankel specializes in both first time and revision rhinoplasty, at the Lasky Clinic. Click here to learn more.

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