Additional Cartilage Grafts in Revision Nose Aesthetics?
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| The photo above belongs to a patient who has undergone rhinoplasty, tip plasty and other nose surgeries many times before. The photo on the left shows the fibrotic, asymmetrical appearance at the tip of the nose, asymmetrical nostrils. The photo on the right was taken immediately after the revision rhinoplasty operation using rib cartilage. |
In some revision cases, the surgeon may need to use additional cartilage tissue to address various issues and achieve the desired aesthetic and functional outcomes. Here are some common scenarios in which additional cartilage tissue may be used in revision rhinoplasty:
Reinforcing Structural Support: In some revision cases, the nasal structure may have been weakened or compromised by the previous surgery. Additional cartilage grafts, often taken from the patient's own septum, ear, or rib, may be used to provide structural support to rebuild the nasal framework.
Correcting Asymmetries: Asymmetry is a common issue that revision rhinoplasty seeks to address. Cartilage grafts can be used to create symmetry and balance between the two sides of the nose.
Enhancing Tip Definition: Cartilage grafts can be used to refine and enhance the definition of the nasal tip. They can be used to reshape the tip and create a more aesthetically pleasing appearance.
Camouflaging Irregularities: In some cases, irregularities or deformities resulting from the previous surgery need to be corrected or camouflaged. Cartilage grafts can be used to smooth out these irregularities and improve the overall appearance.
Restoring Functional Issues: Revision rhinoplasty is not only about aesthetics but also about restoring or improving nasal function. Additional cartilage grafts can be used to address issues such as nasal valve collapse, which can impact breathing.
Filler Dissolution: In cases where the patient has received fillers in the nose as a temporary solution but is now seeking a more permanent correction, cartilage grafts can be used to replace the filler material.
It's worth noting that the source of the cartilage used in revision rhinoplasty can vary. Surgeons typically prefer using the patient's own tissue when possible (autografts) to reduce the risk of rejection or complications. The choice of cartilage source, the surgical technique, and the specific grafts used will depend on the patient's individual needs and the surgeon's assessment of the issues to be addressed in the revision procedure.
Revision Rhinoplasty and Using of Additional Cartilage Tissue
During revision nasal aesthetic surgeries, additional cartilage tissue is needed in some patients to correct existing asymmetries, to create tissue for subcutaneous camouflage, or to reconstruct nasal support cartilage tissue.What is the "Autograft"?
Autografts are derived or taken from the patient's own body and include bone (rib, iliac crest, septal, calvarial) and cartilage (septal, conchal, rib). An autograft is a surgical grafting procedure in which tissue or organs are transplanted from one part of a person's own body to another part within the same individual. In other words, an autograft involves using a person's own tissue or organs for transplantation within their own body. Autografts are often performed when a person needs tissue or organ replacement due to injury, disease, or other medical conditions. Since the tissue or organ is taken from the same individual, there is a reduced risk of rejection by the immune system, as the donor and recipient are genetically identical. This makes autografts an effective and commonly used method for various medical procedures, such as skin grafts, bone grafts, and blood vessel grafts.What is the "Homograft"?
Homografts are obtained from another human donor and include irradiated cadaveric rib and dermis (source >> Premaxillary Augmentation Rhinoplasty Treatment & Management). A homograft, also known as an allograft, is a surgical grafting procedure in which tissue or organs are transplanted from one individual to another within the same species. In other words, it involves the transfer of biological material from a donor to a recipient who is not genetically identical to the donor but belongs to the same species. Homografts are commonly used in medical procedures such as organ transplantation, where organs like kidneys, hearts, or lungs from a donor are implanted into a recipient's body to replace a malfunctioning or damaged organ. The success of a homograft largely depends on factors like tissue compatibility, the recipient's immune system, and the use of immunosuppressive drugs to prevent rejection of the transplanted tissue or organ.How should the characteristics of cartilage be used in revision rhinoplasty operations?
It is not easy to answer this question, but in general, the cartilages to be used in revision nasal aesthetic operations should have the following characteristics:- easy to reshaping
- durable (the rib cartilage has a durable and rigid structure, but the pinna cartilage is flexible and not resistant to pressure)
- after the cartilage grafts are preparing and placing in the nose, the cartilage grafts are not become bent or twisted (especially cartilage grafts obtained from rib cartilages are available for deformity or curvature before the operation is completed), oblique isoniazis technique is used and the nose is kept in serum before it is settled)
- easy to obtain (although the pinna cartilage is easily obtained by surgical procedures, rib cartilag grafting is a little more difficult and painful)
- It is easy to adapt to the tissue, and the risk of infection, tissue rejection should be very low or not at all (there is no risk in the patient's own cartilage cartilage, and if the cadaveric rib cartilage is too low, there is a risk that sterile operating room environment It is important)
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| Human Rib Cartilage Grafting During The Revision Rhinoplasty Operation |
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| Irradiated Cadaver Rib Cartilage |
Many studies shwed that irradiated homologous rib cartilage is well tolerated and safe for use in rhinoplasty operations (source link >> Rib Cartilage Safe for Rhinoplasty)
For patients who have previously undergone repetitive nose operations and who do not want to have an additional surgical grafting procedure, cadaver rib cartilage is perhaps the preferred rescue and facilitating procedure. In pirimary rhinoplasty operations, cadaveric rib cartilage is rarely needed.
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| Irradiated Cadaver Rib Cartilage |
Why revision rhinoplasty operations are difficult?
Depending on many factors such as the difficulty of tissue dissection during complicated revision nose surgery, the difficulty of the surgeon to master the altered anatomical structure due to previous operations, and the fact that the information obtained on preoperative and postoperative examinations are different from each other, "revision rhinoplasty operation is a difficult operation that requires the operating surgeon to know the different surgical techniques during surgery".
Revision Rhinoplasty With Cadaveric Rib Cartilage Video
Surgeons may use cartilage grafts from the rib or pinna (outer ear) in revision rhinoplasty operations for several reasons:
Scar tissue and deformities: Revision rhinoplasty is often performed to correct issues that persist after an initial rhinoplasty procedure. Scar tissue and deformities may be present in the nasal area, making it more challenging to achieve the desired results. Rib or ear cartilage grafts can provide a reliable and plentiful source of cartilage that can be shaped and used to reconstruct the nose.
Structural support: In revision rhinoplasty, the surgeon may need to provide structural support to the nasal framework. Rib or ear cartilage is strong and can be carved into the necessary shapes to provide support to the nose and help correct deformities.
Cartilage availability: In some cases, the patient may have limited or compromised septal cartilage (the cartilage that divides the nostrils) due to previous surgeries. When septal cartilage is not available or inadequate, rib or ear cartilage grafts can serve as an alternative source of cartilage.
Complex reconstructions: Revision rhinoplasty procedures can be complex, involving multiple adjustments and reconstructions. Rib and ear cartilage grafts allow surgeons to have a versatile source of cartilage to address various issues, such as correcting asymmetries, reshaping the tip of the nose, or rebuilding damaged nasal structures.
Natural appearance: Cartilage from the rib or ear can closely mimic the properties of nasal cartilage, which helps in achieving a more natural and harmonious appearance in the reconstructed nose.
It's important to note that while rib and ear cartilage grafts can be valuable in revision rhinoplasty, there are considerations and potential drawbacks, such as additional scarring at the donor site (for rib cartilage) or a need for specialized techniques in cartilage harvesting. The decision to use cartilage from these sources should be carefully evaluated and discussed between the surgeon and the patient, taking into account the specific needs of the revision rhinoplasty procedure.
Source links >> Fresh Frozen Rib Cartilage Grafts in Revision Rhinoplasty: A... : Plastic and Reconstructive Surgery (lww.com) / Harvesting Split Costal Cartilage Graft in Revision Rhinoplasty Without Disturbing the Costal Integrity | SpringerLink / An update on rib grafting in rhinoplasty: which rib is right? - PubMed (nih.gov)
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
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