Ethnic Rhinoplasty (Nose Job), Uncategorized

The Utilization of the Graft In Ethnic Rhinoplasty Surgeries

Bora Ok, MD.

The Utilization of the Graft In Ethnic Rhinoplasty Surgeries

Ethnic Rhinoplasty operations often require the use of cartilage grafts for nasal tip and nasal augmentation. Patient's own tissue or tissues that obtained from the cadavers can be successfully used for this cartilage graft source. The way of usage, the location and the source of the cartilage are determined according to the needs of the patient. The usage of cartilage location may differ in people with different skeletal and skin structures. For example, on a relatively thin skinned person, a single cartilage may be sufficient to support the nasal wings while a few more cartilage may be used on a thicker skinned person or a stronger cartilage source may be preferred. I carry out averagely 25-30 ethnic rhinoplasty operations on a monthly basis, especially on patients who has African origin. 

In addition to this, I try to be more helpful to our patients by identifying the strategies related to the use and location of the grafts with the help of the experiences that I gained in our patients with Asian origin.

1 - Nasal Septum Cartilage: The nasal septum located in the middle part of the nose is a good source of cartilage and can be a surprisingly adequate source especially in patients with low nasal bone skeleton. Since Nasal Septum Cartilage is very similar to the cartilage of the nose tip;
 I prefer to use it as much as possible especially when creating the tip of the nose. In addition to this; it can be used in augmentation the bridge, in supporting the collumella and in some cases, in supporting the alar rims. 
2- Ear Cartilage: Other than nose, ear cartilage also used very often. Generally, with the help of an incision made to the back of the ear, the cartilage in the pit in the middle of the ear is removed without damaging the skin. Therefore no ear shape distortion occurs. The pain level is moderate and the edema and swelling do not disturb the patient unless they are excessive. Usually it is covered locally by using a tennis player bandage approximately for 2 days and rather than incision, follow up process is carried out with dressing. Dissolvable sutures being employed.
In cases where the skin and cartilage need to be utilized together such as in the case of advanced collapse of the nose wings, with the incisions made in front of the ear and the cartilage in the ear pit are removed together with the skin. If this is the case, the coverage can be done by inserting a skin cartilage composite graft that is taken back from the ear. Because of the structure of the nose cartilage, it can be use to make the tip of the nose more prominent or because of its shape, it can be use to subsidize or to imiitate the nose tip cartilage in ethnic rhinoplasty patients. Also, we can shape and use this cartilage and the soft tissue on it on nasal augmentation. I use this cartilage to subsidize the columella cartilage or columella base as well.
3- Rib Cartilage: Rib cartilage is obtained by an incision through the skin on the rib cage. Since there is an evident neccessity of cartilage for ethnic rhinoplasty patients, rib cartilage between 5th to 9th can be used for this surgery. The incision level can be determined by which rib to use, or the rib can be determined according to the incision level. In theory, 9th rib is the one that causes the least flexion after the insertation however because its incesion place is located below the chest wall 5th to 7th ribs usage is more common. If the ribs were to use as small-cut pieces, rectus fascia that is located on the abdominal muscle could also be obtained during the same operation in order to cover these small ribs pieces. People those who in demand of ethnic rhinoplasty usally favours a countoured-looking nose. Because of this reason and because it gives a more predictable shape to the nose; I usually prefer to use one intact or 2-3 pieces of cartilage that stitched together. Rib cartilage is widely used in rhinoplasty surgeries. In some cases such as sunken nasal wing; during which the utilization of the skin and cartilage alltogether is a must;
Some of the seldomly-seen complications are as follows:
• Long-lasting pain and sensitivity
• Scars (Spesicially on black skin: hypertrophic scars and cheloid)
• Deformations on the rib cage
• Pneumothorax (Accidental puncture on pleura)
• Time extention during the operation
• Wrapping (of the rib): Oblique split incision technique and the usage of diced cartilage decrease this risk
• For some people, especially after the age of 40s, ribs getting osseous therefore reshaping might not be the ideal option.
4- Fresh Frozen Rib Cartilage: This is a cadaver costa cortilage which had been pre-sterilized, freezed and prepared after detailed and advanced investigations. This sort of cartilage has different forms: either that had been already pre-shaped or that had been pre-prepared for us to enform it. It can be used safely, it causes lesser pain and requires shorter surgery time compared to other sort of cortilages and causes no morbidity in the patient. Clinical studies have shown that on the long term, this sort of cartilage gives the same results as the patient’s own cartilage. Most of the warping begins to occur between 15-60 minutes during the rib cartilage excerption however in case of fresh frozen rib cartilage usage, this time span is longer and warping starts to occur even later. In addition to that, with the use of oblique spit technique risk of wrapping is minimized.
Click to see MTF website : https://www.mtfbiologics.org/