Cartilage grafts for Nose Jobs/Rhinoplasties:  Pros and Cons

There are three principal supplies for cartilage grafts to build up a nose.  They are the septum (from inside partition of the nose), the ear (conchal bowl cartilage), and rib (either cadaver or one’s own).  Each type of cartilage has its pros and cons for use in the nose and they are worth elaborating.  Perhaps the closest cartilage to an ideal is septal cartilage, not in every case but in many.  It has the strength and the rigidity that is needed for structural grafting but can be hammered thin to act closer to that of ear.  It typically can be harvested during a rhinoplasty, especially a virgin case, in which the nose has not been operated on before since it is oftentimes already taken for a revision procedure.  Removing some septum can also help straighten out the airway and help breathing without compromising any internal structure or support so long as a generous L-shaped strut is left intact within the nose.

The ear cartilage has many good and many bad attributes that can be somewhat modified for clinical usages.  The ear cartilage when removed does not make the ear deformed, as many prospective patients worry.  However, ear or conchal cartilage is incredibly soft and round and is not ideal in many respects for grafting.  Used on the bridge of the nose, it is also a bit too round.  However, for the tip of the nose to contour a soft tip or nostril rim it can mimic that shape well.  To add extra rigidity, a new technology known as a PDS plate has arisen that has been amazing to add rigidity and strength to the cartilage.  The plate, which reinforces the cartilage, dissolves over a period of 6 months or so during which time the cartilage becomes more rigid through scarification process.

Finally, rib grafting can be used for more severe cases in which donor supply of cartilage from the ear and nose are insufficient.  I prefer cadaveric rib graft since there are no donor-site problems like a scar on the middle of the chest, and it works well in malformed noses.  It has incredible rigidity but almost too much and must be thinned down to simulate septum.  Nevertheless, there is considerable amount of cartilage from the rib that can be used and it is a great source for individuals who need a lot of cartilage to improve the shape and structure of the nose.

Sam M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To schedule a consultation please call 972.312.8105. To Learn more about Dr Lams’ rhinoplasty procedures Click Here or to ask Dr Lam a question please visit his rhinoplasty forum Click Here.