"Rhinoplasty Operation - Preparing Cartilage Paste and Placing it Under The Skin" Video

Nasal Ridge Camouflage With Finely Diced Cartilage and Fresh Blood Mud

Video description: During nasal surgery, cartilage paste can be prepared using the patient's own nasal cartilage and his own blood to fill the burrs under the skin, to fill the underside of the nasal cartilage, and to fill the depressed areas on the nose. Similarly, the mixture can be prepared by sanding the cartilage by grasping the side of the scalpel and powdering the cartilage (cartilage dust + fresh blood).

You can find more detailed link about this video at >> Camouflage Method in Nose Aesthetic Surgery With Mixture of Cartilage Powder and Fresh Blood



Image Description: In the photo above, finely chopping of cartilage is shown with the help of a No. 11 scalpel. It can be mixed with fresh blood or placed directly under the skin.

Subcutaneous Camouflage and Nose Augmentation Techniques During Nose Aesthetics Operation

In rhinoplasty operations, when there is an asymmetrical dimpling under the skin or when nasal dorsal augmentation is planned by making exaggerated reduction beforehand, we can use the following tissues and techniques for camouflage or augmentation purposes (especially in revision rhinoplasty operations, these techniques are used more frequently, and many examples from the revision rhinoplasty link on the side. You can access the patient photo, sometimes several of these techniques can be used at the same time):

- Temporal muscle fascia

After a few centimeters of horizontal incision in the temporal region. Since the fascia of the temporalis muscle can be removed and is very bloody, soft and can create a natural edema effect, it is frequently preferred in Augmentation Rhinoplasty Operations. Sometimes an injector can be wrapped around the temporal fascia and stitched end to end, thus creating a natural tube. By filling this tube with the diced cartilage + fresh blood mud that I showed in the video above, an augmentation rhinoplasty operation can be completed on the dorsum of the nose, which can be shaped by hand, with significant volume increase. It is a camouflage and augmentation method that I use frequently. Fasta, after primary synoplasty operations with thin skin; It can be placed under the skin and help to provide a smooth nasal ridge.

- Cartilaginous membrane (perichondrium)

It can generally be used for camouflage of small volume areas under the skin in the nose or in combination with other methods.

- Diced cartilage

It can be used alone or wrapped with surgicell. Generally, when it is not fixed under the skin, there may be a risk of slippage and asymmetric protrusion.

- Cartilage powder

It is the use of cartilages by rubbing with a scalpel and turning them into powder.

- Crushed cartilage

Although the "Turkish Delight Technique", which involves packing the cartilages with surgicell after crushing and laying them on the dorsum of the nose, has been used for many years; If the cartilages are crushed, there is a risk that the cartilages placed over time will be resorbed. It's not a method I use very often.

- Subcutaneous tissue

Especially in thick-skinned noses with ethnic nose features, when open technique rhinoplasty operation is performed, underskin tissue can be removed by performing bilevel skin dissection of the skin in the supratip region. It can be used quite well, especially in nasal root augmentation. At the same time, thinning of the patient's subcutaneous adipose tissue and augmentation of the nasal root are provided. Link group where you can access photos and information about nasal root augmentation on this website >> https://www.ent-istanbul.com/search?q=nose+root+

- Vascular grafts, various membranes used in abdominal surgery

Various industrial membranes, especially used in abdominal and brain surgeries, can be placed under the nose skin for camouflage. However, the implantation of an artificial and industrial tissue in the patient's body may cause an increased risk of effection and tissue reaction. Especially in cases such as open roof deformity, in cases where the nasal air comes into contact with the nasal skin, serious problems such as infection and the discoloration of the skin of these products may occur if the products are placed under the skin in this way. It can be applied in selected patients and patients who do not accept other techniques.

Different from the augmentation and camouflage techniques mentioned above, various artificial bone powders and filling materials can also be used. 

Aurcular Cartilage or Rib Cartilage Can Be Used in Revision Rhinoplasty Operations Without Sufficient Cartilage Graft!

Cartilage grafts can be taken from the patient's auricle or rib in patients who have undergone previous nasal surgery and do not have enough nasal cartilage tissue. Cadaveric rib cartilage belonging to another human can also be used in patients who do not accept the removal of additional cartilage from their own body. Cadaveric cartilage is also human tissue and is more reliable than artificial industrial products.

Camouflage Techniques are Very Important in Revision Nose Aesthetics!

In revision rhinoplasty operations, since the smallest possible surgical trauma is aimed in order to correct the nasal deformities of the patients, only touching the problematic areas, adding tissue or removing tissue are performed. The graft applications I listed above can be used. For example, in a patient who had previously undergone ovarian reduction in the dorsum of the nose and had more tissue removed than normal, the tissue most similar to this removed tissue, such as the temporal muscle fascia, which has the highest risk of circulatory disturbance and infection, can be used for augmentation. Cartilage grafts obtained from the nasal septum cartilage can be used in patients with protrusion of the nasal wing or sagging at the tip of the nose as a result of excessive thinning of the alar cartilages. Camouflage techniques consist of a large surgical dissection and a series of alternative techniques applied in place of surgical trauma.

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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