While most people seeking nasal surgery request that their noses be made smaller, some want or need the opposite – a nose that is larger in one or more particular dimensions. For these patients, success in rhinoplasty often depends on the use of “grafts”. A rhinoplasty graft is a material that is implanted into a patient’s nose to improve its shape or function.
Types of Graft Materials
Most grafts are “autografts”, which means they are derived from the patient’s own body. For rhinoplasty, the best type of autograft material is the cartilage of the nasal septum (i.e. – the sheet of tissue that divides the left and right sides of the nose). This cartilage is flat, strong, easy to shape, and easy to harvest. The ear also provides decent cartilage for rhinoplasty, but this tissue has some drawbacks. Ear cartilage is curved, thin, relatively weak, and requires a second surgical area to retrieve. If septal and ear cartilage are not available, cartilage can also be harvested from the ribs. But, this is more risky and can involve a more painful recovery.
Alternatively, a surgeon may decide to use a “homograft”, which is a tissue that comes from another person. Homografts must be carefully prepared to be safe (often by irradiation) and long-lasting. Examples include rib bone and cartilage. Advantages of homografts are the virtually unlimited supply, and the avoidance of more surgery to harvest the material. Homografts have the potential to shrink after implantation, though.
Lastly, many types of synthetic material are available to form grafts for the nose. Well known examples include Silicone and Goretex. Synthetic grafts also have the advantage of unlimited supply, and come in many pre-formed shapes. Also, they do not shrink or change shape through the course of healing. There are some potential problems with synthetic grafts, though, including the risk of infection and extrusion.
Uses for Nasal Grafts
To improve the appearance of the nose, grafts are often placed under the skin in areas where the nose is deficient in tissue. An example is presented in the figure below.
The photo on the left shows a female patient with a depression on the bridge of the nose called a saddle-nose deformity. During surgery, an autograft of septal cartilage was placed under the skin, and the deformity was corrected, as shown by the photo on the right. Grafts can be placed almost anywhere on the nose to improve its contour. Of course, the shape of the graft is important, and much time is spent carving each graft to obtain the perfect fit. Occasionally, a cartilage graft must by gently crushed to make it more flexible and therefore harder to see through the skin.
Grafts are also very helpful in correcting breathing difficulties. If the sidewall of the nostril is weak, and collapses into the septum with breathing (called “external valve collapse”), cartilage autografts can be used. These are called “alar batten grafts”, and are placed in the nostril wall to make it stiffer. Another common nasal graft is the “spreader graft”, which is a long, thin piece of cartilage that is placed along the bridge of the nose to push the upper nasal wall out and make the airway bigger. It functions like a Breathe-Right strip that is placed under the skin.
The above description is a very brief introduction to nasal grafts, but hopefully it will help to explain some of the complexities of graft use in rhinoplasty surgery. If you are considering a rhinoplasty, our doctors would be happy to discuss the need for grafts during your consultation.
