Q: After two rhinoplasties (a good minor tip refinement in 2001 and a rather aggressive septo-rhinoplasty in 2009 which contrary to my request shortened and upturned my nose a little), my aim is very mild tip lengthening, about 1.5 to 2mms and downward rotation. There are no problems of symmetry or breathing now, but my doctor used columellar strut, dorsal onlay, tip onlay and peck grafts and believes that my septal cartilage is probably inadequate so an ear graft must be used. Is this a safe solution for a very small improvement, or could the removal/repositioning of some used graft contribute to slight de-rotation? Can a combined solution, or even the use of hyaluronic acid, provide the best and least risky solution? I would really appreciate even a very mild lengthening/de-rotation, and much is being reported about the impressive progress in stem cells engineered cartilage. I really hope that you might be able to help me without extreme procedures and considerable risk.
A: To lengthen and de-rotate your nasal tip slightly, an onlay graft is a good solution. For the small amount of change that you want in your nasal tip, building out the area with a graft would be the most predictable. The use of ear cartilage grafts from the concha in rhinoplasty is very common, safe, and produces predictable results. It is a simple cartilage to harvest as it is taken from the back of the ear, leaving no visible scar. The natural curve of the cartilage is quite good for use in the nasal tip, which has numerous curves to it. The use of injectable fillers will produce your desired result quite simply but will go away in six months or less so it would need to repeated with some frequency and expense. Cartilage grown from stem cells currently remains a laboratory technique that may one day be useful in humans.
Dr. Barry Eppley