Q:How difficult would it be to remove a dorsal onlay graft composed of a continuous piece of septal cartilage? The underlying structure of the nose was not changed.
A: Cartilage grafting in rhinoplasty is commonly done for a variety of structural enhancement reasons. Building up the bridge of the nose, widening the middle vault, and supporting and expanding the tip of the nose are common reasons for the use of cartilage grafts in rhinoplasty. Raising up a low dorsum, also known as the bridge of the nose or dorsal augmentation, can be done with cartilage grafts or synthetic materials. When possible, the use of your own natural cartilage is always best as it poses no long-term problems in terms of infection or tissue reaction. The most common problems with cartilage dorsal augmentation is shifting or asymmetry of the graft, underprojection (not enough height) or overprojection. (too much height which is rare)
Cartilage grafts to the nose heal with a surrounding capsule or scar. Inside this envelope sits the cartilage graft. Much like the original mucoperichondrial lining from which it was harvested (septum), this lining can be raised up and the cartilage graft exposed and removed. The cartilage grafts do not heal and become one with the surrounding cartilage like a bone graft would do in other areas of the face. There remains a clear demarcation between graft and the surrounding tissues. It should not be a problem to remove it in one-piece although it is best done through an open rhinoplasty approach.
Because it is a septal graft, it is unlikely that enough volume has been placed to make the graft too big or too high. I would be curious to know what about the graft makes you want to remove it.
Dr. Barry Eppley