What Is The Best Way To Build Up My Bridge In Rhinoplasty Surgery?

Q: Dr. Eppley, I am a young African-American. man. I am looking into augmentation rhinoplasty. The concerns I have with my nose are its wide nostrils, bulbous tip, and low bridge, in order from most distressing to least. The internal structure of my nose is in great condition. I have no trouble breathing. My septum is in pristine shape, full of cartilage with no deviation. Cartilage grafting and an alar base reduction seem to be the best course of action. I am looking for a surgeon who can reasonably achieve what I’m looking for and do it affordably. I’ve attached pictures of myself below. I am asking that you provide me with a quote for the rhinoplasty procedure. I completely understand that without a physical examination you cannot give an exact quote, but I’m certain that the doctor or director can give a reasonable price range based on the information I have provided.

A:Thank you for your inquiry and sending your pictures. You have clearly outlined your rhinoplasty needs/goals of which augmentations of the dorsum, tip narrowing and elevation and nostril reduction are the cornerstones of it. The key issue in any augmentation rhinoplasty is what type of material does one want to use to do for the building and how much of a build does the patient want or need. For the tip of the nose septal cartilage is always used for the columellar strut and onlay tip grafting, there is not any debate at this augmentation area. It is the bridge (dorsum) where the discussion lies.

The bridge can be built up using three types of materials, septal and rib cartilage and an implant. Each has their own advantages and disadvantages and the results are not always similar. When using septal grafts this supply is limited and given that some of that is used for the tip there is not as much available for the bridge as one would think. Thus using septal cartilage for the bridge will only create 2mms or so of augmentation. (see attached 1st rhinoplasty prediction) More substantial cartilage augmentations require rib grating where the amount of buildup is more substantial because there is more material to use. (see 2nd rhinoplasty prediction) Thirdly the use of an implant (hand carved ePTFE not silicone) works really well in isolated bridge augmentations and produces maximal augmentation results like rib grafts but without the donor site and less operative time to perform.

Knowing how you want to do your augmentation rhinoplasty will allow a proper cost of surgery to be provided.

Dr. Barry Eppley

Indianapolis, Indiana