A graft is any tissue that is taken from the body to use in another area of the body of the same person or another person. When we talk about grafts in the nose, we are talking about cartilage, soft tissue (fat and fibrous tissue), or sometimes bone that is used to improve the structure and shape of the nose. Sometimes synthetic materials such as Silicone or Goretex are also used in the nose as implants. There are differences in the properties and uses of these materials. In general, the majority of grafts that are used in the nose are usually made of cartilage.
Cartilage grafts are small bits of cartilage that are carefully carved and shaped. They are used to either reinforce weak tissues or replace tissues that have been lost to trauma or removed during surgery. Most patients who require a number of grafts are seeking revision rhinoplasty to fix things after their nasal tissues have been too aggressively removed. Or, they may have a small nose or flattened bridge to begin with and wish to have it augmented, such as in some ethnic rhinoplasty. In these cases, it’s not uncommon for many different types of grafts to be used in the same nose, each playing its own unique role. Patients seeking primary (first-time) rhinoplasty for reduction of a bump or for refining their features usually do not need grafts.
Grafts in the nose can be broken down into contour grafts or structural grafts. Contour grafts are used when the surface or appearance of part of the nose needs to be smoothed out, better defined, or built up. We use these on the bridge when it is too low or scooped, on the side of the nose when there is an irregularity or a depression, or on the tip to change its shape. Structural grafts are used when the nose needs more support such as when the tip is pinched and collapsing, or when the bridge is overly thinned and affecting nasal breathing. In these cases, the graft performs both functions: both improving support and nasal breathing, and achieving the look you want for your nose.
We prefer to use your own cartilage for grafts whenever possible. These can be taken from your septum (the center wall of your nose), the bowl of your ears, or your ribs. In any of these locations, you won’t miss the cartilage that is being ‘borrowed’. Your ear or chest should not look any different after this cartilage is removed. The decision of where to take cartilage from depends on the amount, strength, and rigidity of the cartilage required.
This photo shows a tip graft being placed during a Revision Rhinoplasty by the Profiles Surgeons, Drs. Solieman and Litner. This patient had much of the tip cartilages removed during a previous Rhinoplasty and a tip graft was used to help increase nasal tip projection and definition.
The appearance of grafts after surgery depends not only on the shape and size of the graft but on other factors. If your nasal skin is very thin, very precise details of the graft may show through. That is not always desirable because tiny irregularities can be seen and the transition between the edge of the graft and surrounding tissue can be visible. In these cases, we may use some soft tissue over top of the graft to provide some thicker coverage under your skin. On the other hand, if your nasal skin is very thick, a larger graft may be necessary to provide the definition you want or the support that you need.
With every graft that is placed, there is a small risk that it will be visible, that it might move, become infected or get absorbed. We do things to prevent this like suturing the graft precisely in its place so that it has the best chance of healing well.
For these reasons, grafts should only be used when and where they are needed. We weigh these factors every time we are considering using a graft. If your surgeon suggests a graft, you should have a clear idea of the What, Where, Why, and How of the whole process. Grafting should make sense.
Please feel free to ask us any more specific questions you may have.2 comments
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