Q: Dr. Eppley, I have had five previous rhinoplasties to get my nose built up the way I want it. At the last surgery, the doctor put in a silicone implant. While that make it look better, it is still inadequate. What I want to know is whether diced cartilage can be used to make my nose bigger as it is still too small. What are the side effects of diced cartilage in the nose?
A: If I understand your question correctly, you are asking whether a diced rib cartilage graft will make for a bigger nasal dorsal augmentation that an exiting silicone implant. The answer might be yes although a more accurate answer would come from knowing exactly what type and size implant is in your nose and what you looked like before it was placed. In most cases, a rib cartilage graft offers more volume than an implant given the amount of rib cartilage that can be harvested. A diced rib cartilage graft can also be molded and shaped much better than an implant without the risks of warping or external deformity. That is the value of dicing a solid rib, it because moldable like clay material when placed in a sheath of surgical or fascia. With any rib graft, there would also be no long-term risk of infection or displacement which is always a potential issue with a synthetic implant. Also understand that the silicone implant must be removed and replaced by a cartilage graft, you can not or should not add a cartilage graft over an indwelling synthetic nasal implant.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in getting my nose built up. I think it is too small. I really don’t want to have a rib graft taken so I am looking at synthetic implants. I am trying to decide between a Voloshin and a Shirakabe nasal implant. Does a Voloshin or Shirakabe implant give a more streamlined appearance? Which implant enhances the nasal tip more? Is the Shirakabe Nasal tip too narrow? Secondly,what is the purpose behind using the Brink Peri-Pyriform Implant in rhinoplasty?
A: The fundamental difference in the Shirakabe nasal implant from that of the Voloshin is that it provides some augmentation to the base of the nose. But that is irrelevant if one is going to have a peri-pyriform (premaxillary) implant. The Shirakabe tip is a morenarrow, particularly across the tip, compared to the Voloshin. One thing you have to be very careful of is to not make the entire nasal tip cartilages (dome) completely covered by the implant. While one can get away with big sizes in facial implants that are covered by muscle, the risk for implant problems (infection, extrusion) that are covered just by skin (such as the nose) is not so foregiving. So I would not get hung up in trying to give the nasal tip too much projection with an implant. That places the skin under tension and is a setup for the aforementioned problems. If one wants to push the envelope of size and tissue tension in the nose, it is far better and less risky to do this with a rib graft.
The purpose of the peri-pyriform (premaxillary) implant in rhinoplasty is to build out the base of the nose in cases of midface deficiency and a smaller nose. This opens up the nasolabial angle, increases the fullness of the upper lip and pushes out the base of the nostrils. This in effect creates a pulling out of the nasal base.
Dr. Barry Eppley