What Is The Best Rhinoplasty Material To Use To Build Up My Nose?
Q: Dr. Eppley, There are several parts of my face that I wanted to improve, but I feel like the nose is the most significant feature that I want to change. I attached some pictures which show the amount that I want my nose to be built up. I would like to know if this is realistic. What is the best way to accomplish this, implants or your own tissues. I have heard implants can get infected and that rib cartilage is known for warping. I am uncertain as to which choice to make. What do you recommend?
A: What you are demonstrating is nasal dorsal augmentation from the frontonasal junction down to the supratip area below and behind the lower alar cartilages. The greatest amount of dorsal augmentation is in the radix because it is also the lowest. I think the kind of result you have imaged is realistic.
The major question is what material to use for nasal dorsal augmentation. There are two main choices; synthetic implants and rib cartilage of which I have used both. (although many more rib cartilage grafts than implants) While there are advocates for each, I would heavily lean towards the use of rib cartilage given your young age and skin type and quality. While it requires a greater investment of time and recovery up front, the use of your own tissues will not give you any infection, extrusion or tissue thinning problems for the remainder of your long life. In using rib cartilage, it can be done as a whole piece or as a fabricated diced roll construct. Which one is better is based on the quality of the rib tissue harvested and surgeon’s preference. Because most rib cartilages have some curve to them, it requires good surgical technique in how to harvest and shape them to avoid the potential for warping concerns. I always use the cartilages from either the 8th or 9th rib. Sometimes a very straight piece can be obtained and shaped and then I use it as a solid graft. If the rib is very curved and a very straight piece can not be fashioned out of it, then it is cut into very small pieces (1mm) and packed into a surgical wrap to create a very moldable long implant like a piece of sausage. Once in place it is easy to shape and the splint after surgery holds it into place. It becomes very solid in a short period of time as the small pieces of cartilage allow very rapid fibrovascular ingrowth. As a young man, you should have very good rib tissue and I suspect the solid rib graft for your rhinoplasty will work just fine. That has been my experience in younger male patients.
Dr. Barry Eppley