Nasal Dorsal Augmentation

Q: Dr. Eppley, I need a lot of nasal dorsal augmentation. I looked at your gallery and like your work very much. And I would like to know if you would recommend rib cartilage or donated cartilage or artificial material in patients with very low nose bridge. Looking forward to hearing from you. Thanks!

A: There are three material methods of nasal dorsal augmentation, each with their own advantages and disadvantages. A synthetic implant, like ePTFE, offers an off-the-shelf augmentation material that can be carved and customized for each patient and offers an augmentation method that is assured of a smooth contour and not to warp after placement. But it does come with some risk of infection being a synthetic material. Autologous rib grafts offer the most natural material and lowest risk of infection. But it does requires a donor site, costs more to do and has some risk of warping and asymmetry. Cadaveric rib cartilage is like an intermediary material between an implant and one’s own rib cartilage. It is not an implant but then again is also not like one’s own rib cartilage either.

As you can see there is no perfect dorsal augmentation material and rhinoplasty surgeons often use what they are most familiar with or have used in the past. Having used all three nasal augmentation materials, my preferred choice comes down to educating the patient and having them decide which nasal material is most appearing to them. The only caveat in your case in that you said you need a lot of augmentation. I would have to see what a lot means as that may sway the decision in favor of one of the nasal augmentation materials.

Dr. Barry Eppley

Indianapolis, Indiana