If you’ve been thinking about getting a Rhinoplasty (nose job), then you’ve probably come across the term “cartilage rhinoplasty” or “cartilage graft nose job” or something similar during your search. So, what is cartilage graft rhinoplasty? The short answer is that cartilage graft rhinoplasty is a surgical procedure performed to enhance the shape of the nose with cartilage grafts, also known as malleable tissue. This tissue is harvested from either the ears (auricular), ribs (costal), or nasal septum (septal). And, is a common technique used in augmentation rhinoplasty.
What is cartilage?
Cartilage is a type of tissue that can be found in many parts of our body, for example, your ears. If you feel your ear right now you’ll find that it’s hard enough to hold its shape perfectly, yet not so hard that you can’t fold it in on itself. While cartilage is solid, it’s much softer than bone, it is flexible and malleable. The lower half of your nose, your nose tip, and nasal septum are also made of cartilage.
What is cartilage graft rhinoplasty?
Rhinoplasty is a cosmetic procedure done to reshape the nose. There are many types of rhinoplasty and many different techniques to build a perfect nose. How this is achieved depends on your natural anatomy and your desired appearance. Everyone is different and each surgery is customised to accommodate the patient’s desires. While some people want to reshape their nose to make it smaller and less protruding (nose reduction), others want the opposite (nose augmentation) or they want to reshape their nostrils (alarplasty).
If you’re looking to make your nose larger, your surgeon will have to either implant a synthetic implant (made of plastic or Gore-Tex) or use natural body tissue to reshape your nose. Cartilage is a natural body tissue and has been used for decades as graft material.
A cartilage graft means that your plastic surgeon will collect cartilage tissue from another part of your body, and incorporate that tissue when constructing and reshaping your nose. As mentioned above, cartilage can be found in many sites of your body. However, it is commonly harvested from the ribs, ears, or the nasal septum during rhinoplasty.
Who needs cartilage graft nose surgery?
A cartilage grafting nose job is recommended for people who want to get an augmentation rhinoplasty to;
- Raise their nasal bridge,
- Improve nasal projection
- And/or augment their nasal tip (tip plasty).
- If you want to make your nose bigger, then you’re probably a good candidate for cartilage grafting.
Your ethnicity can impact your facial features and certain ethnicities require different surgical methods and approaches especially when it comes to facial surgery. What may work for Caucasian patients, may not for Asian, European or African American patients and vice versa.
Nose jobs have become so popular among people of Asian descent, that we now have a specialised procedure known as “Asian Rhinoplasty”. Asians tend to have less developed nasal bones and cartilage, so the nasal bridge is usually convex and does not project much. The tip tends to be narrow, small, and without much protrusion. Asian patients and others request nose augmentation, which can be done using a synthetic prosthesis or cartilage.
Other conditions that might require augmentation rhinoplasty and cartilage grafting include short nose syndrome (associated with cleft palate), nose trauma, and collapse or weakness in your nose cartilage that requires nose reconstruction surgery.
What are the different types of cartilage grafts used in nose jobs?
There are several types of cartilage grafts used in rhinoplasty and there’s debate over which one is the best. Each type of cartilage has advantages and disadvantages and, generally, it is your surgeon’s experience (and not the type of cartilage)that is more important in determining the outcomes of rhinoplasty.
There are three types of cartilage grafts used in rhinoplasty:
Septal cartilage graft
The septum is the wall of cartilage and bone that separates your two nasal cavities on the inside. During rhinoplasty, your surgeon might cut out a small piece of septal cartilage and use it to augment another part of your nose and reshape it. This technique is more likely to be performed in Caucasian and not Asian patients since the latter usually have underdeveloped nasal septal cartilage. In other words, there is not enough tissue to harvest.
When possible, however, many surgeons choose septal nose cartilage for augmentation rhinoplasty over other types of cartilage because it can be easily harvested during surgery. Furthermore, as the tissue is from the nose itself, it’s more likely to adapt perfectly when re-implanted. This also makes the septal cartilage less likely to bend or warp over time compared to the other types. For this reason, septal cartilage is perfect for reshaping your nasal bridge.
Ear cartilage graft
This is also called a conchal or auricular cartilage graft. Your surgeon may choose this method, which requires cartilage to be harvested from the bowl of your ear. It’s important that you know that this will not in any way change how your ear looks, and won’t leave any visible outer scars.
Ear cartilage is softer than septal cartilage, which means it’s easier to reshape and sculpt into the desired shape. This high malleability and natural curvature of ear cartilage makes it perfect for nose tip augmentation and reshaping (tip plasty). Your surgeon will cut and sculpt the auricular cartilage into small pieces during nose tip surgery and will then strategically implant the cartilage to enhance nasal tip projection.
Rib cartilage graft
This is also called costal cartilage grafting. The main advantage of using costal cartilage in rhinoplasty is that there’s a large amount of it available to harvest without causing any functional disturbances to the ribs. Costal cartilage is firmer, but it’s more likely to warp and lose its shape over time. Another disadvantage is that it requires more operative time, and as a result, it increases the direct and indirect costs of surgery. Costal cartilage nose jobs are usually reserved for cases where extensive nose reconstruction is necessary.
Nose augmentation with cartilage grafting is usually done using the open nose job technique (as pictured below). Your surgeon will cover the cartilage with normal tissue to hide it so it’s not visible under the skin. When the surgeon is satisfied with the size and shape of your nose, he/she will close the small skin wound using resorbable or non-resorbable stitches that are very well hidden in the skin fold under your nose. This means that rhinoplasty does not usually leave a visible permanent scar.
What are the advantages and disadvantages of nose implants?
If you want to make your nose bigger, alloplastic nose implants are one of the options available. These implants are usually made of silicone or Gore-Tex. The advantage of nose implants is that they are safe, customizable, and cheap.
The disadvantage is that they are synthetic. In other words, you’ll be implanting foreign material into your body. As a result, synthetic nose implants can carry a higher risk of infection which in turn can have dramatic effects on the appearance of your nose. Moreover, much like with breast implants, capsular contracture can occur. This is when fibrous tissue forms around the implant which causes the nose to become misshapen and disproportional. If this was too occur you would require nose revision rhinoplasty to correct it.
What are the advantages and disadvantages of cartilage grafts in nose surgery?
When comparing the pros and cons of cartilage grafts in rhinoplasty to those of synthetic nose implants, several advantages make cartilage the graft of choice for many surgeons. The main advantage of cartilage grafts in nose surgery is that cartilage is a natural body tissue. S0, it will incorporate into your nose easily without causing an immune response and risking inflammation, infection, and rejection. Nose implant rejection can be devastating and usually requires removal of the implant. Moreover, since cartilage is your body’s own tissue, it’s more likely to blend more smoothly with the rest of the nose which will give you more natural-looking results. Cartilage also offers a mix of flexibility and firmness, which makes it perfect for reshaping your nasal tip, rebuilding your nasal bridge, or enhancing and augmenting your nose.
The disadvantage of cartilage is that it might require more surgical time to perform when compared to using synthetic nose implants. Furthermore, harvesting cartilage from the ribs may leave an unwanted scar, but this is not the case with ear cartilage. The incision can be very well hidden and leaves a nearly invisible scar. Another disadvantage of cartilage grafting is that cartilage may bend and warp over time, which can lead to a crooked or asymmetrical nose. This, however, largely depends on the skill and experience of your ENT or plastic surgeon and not on the cartilage itself.
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How long do cartilage grafts take to heal?
A rhinoplasty (with cartilage grafting), will require 1 to 2 weeks of rest at home. During this time, the swelling will subside, the bruising will improve, and there will be less discharge from your nose. However, you should wait at least 6 weeks or until cleared by your surgeon before you return to any contact sports.
Is rhinoplasty safe?
Rhinoplasty is generally a safe procedure that carries minimal operative risks. Like any other surgery, complications can still occur. However, with rhinoplasty, these are less likely to occur. Some postoperative complications that uncommonly happen include infection or bleeding.
Is rhinoplasty painful?
During surgery, you will not feel anything since you will be either under general anaesthesia (asleep), or your surgeon will inject a local anaesthetic into your nose. Either way, you won’t feel any pain. While after rhinoplasty, you should expect to experience some degree of pain during the healing process. Your surgeon will prescribe painkillers that will help ease any discomfort.
Does Medicare cover rhinoplasty?
When performed for purely cosmetic reasons, a rhinoplasty will not be covered by Medicare. However, if the nose job is medically necessary due to either breathing difficulty, nose deformity or nose trauma, you may be eligible for a rebate.
How to Find the Best Rhinoplasty Surgeon
When looking for a plastic surgeon to complete your procedure, doing research is VITAL. You need to ensure that the person you choose not only has the qualifications and the experience to perform your procedure but also the before and after photos and testimonials from past patients. Avoid any cheap nose deals or special package offers by less qualified doctors.
With a wealth of experience and training, Dr Stephen Kleid, MB BS FRACS Ear, Nose and Throat Surgeon and Dr Richard Sackelariou FRACS (Plas) are dedicated to best-practice patient care and education. They customise each nose reshaping surgery to best meet their patients needs and desired surgical outcomes, including; nose reshaping, septoplasty and open and closed Rhinoplasty techniques in Melbourne and Sydney with a focus on natural-looking results for both women and men.