Q: Dr. Eppley, I have few questions about rhinoplasty grafting. A few surgeons that prefer implants have told me that they do not prefer diced cartilage wrapped in fascia because the cartilage tends to flatten and the borders are irregular. Other surgeons have said that it lasts a lifetime if placed correctly. What has been your experience and what do you prefer as a natural substance? Also, does skin thickness have anything to do with implant extrusion? My skin is thin but my implant was placed properly and very well because there is no deformity and the skin is smooth. Also, what is alum from a cadaver? I have heard that this is something relatively new.
A: It is impossible to beat your own cartilage as the best natural and permanent nasal augmentation material in rhinoplasty grafting.. How to best shape the cartilage for the desired result depends on the source of the cartilage, the amount that can be obtained/needed and the surgeon’s ability to work with the material. It is not as simple as just using cartilage any way one wants. If one can harvest a nice straight piece of rib cartilage then that would make the perfect dorsal augmentation method to carve and shape. But many pieces if harvested cartilage are not straight and be diced and wrapped to ensure a straight result. It has not been my experience that diced cartilage grafts flatten out and create irregular borders. I will not use any type of cadaveric material for nasal grafting so I can not comment on its use.
Dr. Barry Eppley