What are the risks of using your own diced rib cartilage wrapped around your own fascia?

Posted on March 21, 2017 by Donald B. Yoo, M.D.

Q: 1. What are the risks of using your own diced rib cartilage wrapped around your own fascia? 2. How do you make decisions to use either diced or whole rib cartilage for the bridge augmentation? 3. Heard rib cartilage could warp over time when used for the bridge. What is/are alternative(s) other than using foreign materials? 4. Have Gore-tex for my nose. It fell on the right side of my face and made my nostrils look uneven. Is this an emergency? Would this change my bone/skin structure?

A: The diced cartilage fascia technique does require special expertise and a great deal of experienced to create consistent, predictable results.  The most commonly encountered issue is contour irregularities and asymmetries – as with any technique for dorsal augmentation.  In skilled hands, the diced cartilage fascia technique provides permanent, natural and attractive results, but in inexperienced hands can be unpredictable and inconsistent.

Diced cartilage fascia provides permanent results without the risk of warping or resorption of en bloc rib cartilage, and with a much lower rate of migration, infection, or extrusion than synthetic grafts.

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Is it a safe method to use goretex placed in to the bridge of your nose, and ear cartilage on the tip?

Posted on March 11, 2017 by Donald B. Yoo, M.D.

Q: Hi I had my rhinoplasty done for 15 days now. My surgeon used goretex at my bridge and ear cartilage with my tip. I was not aware that the first option and much safer if full cartilage graft. I am worrying now for the future infections or rejection.

A: While Gore-tex and other synthetic implants have a higher rate of complications than using tissue from your own body, you are certainly not at any immediate risk.  While there is a higher risk of infection and extrusion – infections can typically be treated with antibiotics and extrusion is more of a long-term issue.

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I am an Asian revision rhinoplasty patient. Can my septum become deviated and weakened if I allow it to be harvested for grafts?

Posted on March 11, 2017 by Donald B. Yoo, M.D.

Q: My septum’s always been a little deviated & I worry it is a little deviated after a trauma. I noticed the most change after a 2nd revision. In primary, I had a rhinoplasty that elevated my tip/nostrils. I was hit very hard in the tip (no bones broken), but now, after a 2nd procedure that involved harvesting a single shield graft, the nasal tip was lowered. The right side was harvested for material. My left nostril now seems closed. I want to raise my tip again. What am I at risk of now?

A: During Asian rhinoplasty, the septum can serve as a good source of cartilage to create structural grafts to reshape the nose.  It is important to preserve enough cartilage in the native septum to allow for normal strength and structural integrity.

If septal cartilage has been previously harvested, then many times it is a better option to obtain cartilage from a different donor site (ear cartilage vs. rib cartilage).  The degree of change you are hoping to achieve will dictate the best cartilage source – and this is best determined after an in-person consultation with an Asian Rhinoplasty Specialist experienced with revision rhinoplasty.

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Extremely red tip after Asian rhinoplasty with cartilage grafting – normal part of the healing process?

Posted on March 11, 2017 by Donald B. Yoo, M.D.

Q: I had Asian septo-rhinoplasty 3 days ago, with ear cartilage grafts to the tip. This is my first rhinoplasty. Today, I noticed my tip has gotten very red. I have not touched the tip at all and have been keeping up with my antibiotics. It was not red after the procedure and it only became red today – I know it’s only been three days, but is this a normal part of the healing process? Thanks!

A: It would be unusual to develop an infection that early after rhinoplasty, and the redness is likely more a product of the tension exerted on your nasal tip skin by the underlying grafts.  However, it is always prudent to inform your surgeon of any concerns and to follow up closely with him/her to ensure the best results.

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I had a Medpor strut graft removed and now my breathing is worse. Can I replace it?

Posted on March 11, 2017 by Donald B. Yoo, M.D.

Q: I am a thick skinned, wide-nosed Asian patient that had Medpor bilateral strut graft & ear cartilage in my middle nose in a functional & aesthetic rhinoplasty. It narrowed my nose & helped me breath through both nostrils really well. I had it removed based on bad medical advice, am breathing poorly now & feel I need a similar structure in my nose. So long as I have scar tissue removed in revision, can’t I have the implant replaced w/ear? Why should I go through harvesting so much cartilage?

A: Medpor is inferior in the nose relative to autologous grafts (tissue from your own body) for many reasons, not least of which is its higher rate of complications.  Ear cartilage is great for contour grafting, but is at times too flimsy to provide adequate structural grafting.

One misconception of cartilage grafts is that it prolongs recovery after rhinoplasty.  It actually does not prolong it at all because during the week you have a cast and sutures on your nose, your donor site is also healing.  The cast and sutures on your nose and donor site are all removed together at one week, and thus everything heals together and recovery is not lengthened one bit.

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What Asian nose surgery would you recommend?

Posted on March 10, 2017 by Donald B. Yoo, M.D.

Q: I’m from India, but we are tribal so I have a very flat nose. I’m very uncomfortable using my spectacles and shades. Please suggest what kind of nose job will be best for me.

A: You will need to add volume to adequately build up the bridge of your nose (dorsal augmentation).  Based on the degree of change you’re trying to achieve, this could be accomplished with cartilage from inside your nose (septum) and cartilage from both ears, or cartilage from one of your ribs.

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Can the removed hump be used to build the bridge?

Posted on March 10, 2017 by Donald B. Yoo, M.D.

Q: In asian rhinoplasty using all natural cartilage, where I am looking to reduce my hump while slightly augmenting the bridge, can the hump be slid up and used as a graft to build the bridge? Wouldn’t this be better than ear cartilage since it is made of the same material as the nose bridge itself? Thanks!

A: One consideration your surgeon must be careful to assess is the height of your radix (bridge between your eyes) in relation to your “hump” or pseudohump.  Often in Asian rhinoplasty surgeons will attempt to reduce the hump in a misguided attempt to straighten the profile instead of augmenting and building up the radix.

If a significant amount of cartilage needs to be removed, then it may be possible to use it to augment your bridge using that cartilage, but it is rarely the best graft option.  The width, height and length of the graft needs to be precisely tailored to provide a natural, smooth contour – and the amount of cartilage removed from the hump rarely provides this in Asian rhinoplasty.

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Would an alarplasty or tip plasty be enough to make my Asian nose slimmer and more defined?

Posted on March 8, 2017 by Donald B. Yoo, M.D.

Q: I’m not so concerned about a high nose bridge. It’s just that the tip of my nose is so large, it swallows up my face, especially when I smile. It’s also pretty wide and flat; in some photos it’s like I have no nose and the whole thing is flat until my nostrils. I’d like it to be a bit more defined and feminine. I’d like a minimally invasive procedure, so is alarplasty or tip plasty enough to improve my nose? What procedures can be done to make my nose fit better with my face?

A: Since your concern is primarily your tip, it is possible to reduce the width and bulbosity of the tip of your nose without altering the appearance of  your bridge.  The width and flare of your nostrils can be addressed as well with alar base modifcation.

The proportion of the width of the tip and the width of the nostrils is very important.  If the nostril width is reduced without reducing the width of the tip, the tip will look even more bulbous and wide in comparison.

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What is the best revision of rhinoplasty in Asian nose?

Posted on March 8, 2017 by Donald B. Yoo, M.D.

Q: I’m Asian and I had nose job last 3 months ago, and it’s a perfectly done but I’m scared for possibility bad effects of it. This is a hard L shaped silicone implant. I’m planning to remove it and change to silicon soft implant and ear cartilage for my tip. Do you think this is a good option? How long that the ear cartilage last?

A: While there is no urgent need to replace the silicone implant, it will likely need to be removed in the next 10-20 years, if not sooner.  Since it is a foreign body, the silicone will not become incorporated into your nose and it will gradually thin out the skin of your nose.

Cartilage from your own body (septum, ear, or rib cartilage) will last permanently.  However if you like the look of the silicone implant, ear cartilage may not be sufficient and rib cartilage may be necessary to achieve the same degree of augmentation and refinement.

Consultation with an Asian rhinoplasty specialist experienced with autologous grafts will help you to carefully weigh the available options.

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My bridge is significantly off-center after osteotomy. How long do I have to wait before getting a revision rhinoplasty?

Posted on March 8, 2017 by Donald B. Yoo, M.D.

Q: Had asian closed rhinoplasty (primary) 3 months ago. I had a small hump shaved down and osteotomy performed to bring the nasal bones together. My bridge before surgery was perfectly centered, but now my bridge is very off center (5 mm closer to one eye than the other) and everyone (even my ENT doctor, who I went to see for an unrelated issue) notices it immediately. It’s bad. How long do I have to wait before I can get a revision rhinoplasty with osteotomy to move my bridge back to the center?

A: After an endonasal (closed) rhinoplasty, if your main concern is reshaping the dorsum (bridge) of your nose during a revision, this may safely be addressed as soon as 6 months after the initial surgery.

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