Q: Dr. Eppley, I am seeking a revision rhinoplasty. I had my primary rhinoplasty done six months ago. The method used was diced ear cartilage wrapped in fascia to increase bridge and tip height. What I’ve noticed in my bridge is that it slightly decreased in height possibly due to swelling going away. With the swelling gone, the bridge height isn’t as augmented as I had wanted. For a revision,I wanted to know if Dr. Eppley would consider using the diced cartilage injection technique.Looking for very slight increase in bridge height.I feel that cartilage injection best suits my case.That minor change can make a huge difference. As I have read in some of your articles concerning revision rhinoplasty, many patients desire a revision rhinoplasty because they may be seeking the optimal look for themselves and may not be a result of aesthetic unhappiness with what their previous surgeon performed. In my case, I feel as if my surgeon did an excellent job with my rhinoplasty. My only issue now is that I was extremely gratified in the first three to four weeks with my nose but failed to realize that the swelling played a role in that. Now that the swelling has almost subsided completely, I am looking to add enough bridge height to replicate what it looked like in the first month post surgery. I can’t stress to you enough how little of an increase in bridge height I am desiring, but it’s enough of a change to make a huge difference for me.
A: Thank you for our detailed rhinoplasty history. For a modest increase in dorsal height, I would agree that an injection of diced cartilage, done through an intercartlaginous incision, should be appropriate.While the concept of an injection always sound simple, it is important to note that cartilage must be harvested, prepared and then injected. The question is where that cartilage should come from…the contralateral ear or the septum? Either way this usually requires more than a local anesthetic in most cases.
Dr. Barry Eppley
Q: Dr. Eppley, do you do injectable cartilage? Can this be used to give support in the nostril sill area? My sills were partially removed from a bullhorn lip lift and I thought the cartilage injections might rebuild the area. Dr. Onor Emrol in Istanbul says the injectable cartilage can be used in this area but I can’t really travel that far and he doesn’t do phone consults. I have scarring at the base of the nose loss of nostril support from the liplift and the sills were partially removed due to where the incision was placed. Also can the injectable cartilage be used to do premaxillary augmentation. I want to move forward the nasolabial angle. The nasolabial angle is now caved in due to being scarred down from the liplift and I need to increase the angle push it away from my face.
A: I have done numerous diced cartilage grafts, whether it is by injection or with a rolled graft fabrication in fascia or surgicel collagen material. The key questions are whether such cartilage grafts will work for your two indications and what volume is needed. From a premaxillary/paranasal augmentation standpoint, the issue with using cartilage is the volume of donor material needed. The septum will not have enough material to create enough push to make a visible difference in these areas. To get good volume, a lower rib donor source is needed where a good bloc can be removed and used. Whether one dices up the cartilage or injection below the skin and places it at the bony level in a carved form just like a synthetic paranasal-premaxillary implants is a matter for further discussion. From a nasal sill standpoint, the septum or ear will offer enough material to dice and injected beneath the scarred nasal sill area. While this will not replace lost skin that was removed from the lip lift, it will provide subcutaneous volume to push out on the area.
Dr. Barry Eppley