A very common question asked by man patients undergoing revision rhinoplasty, Asian rhinoplasty and ethnic rhinoplasty as these are the types of nose job surgeries frequently necessitating the use of cartilage in addition to what is available in the nose. By now most patients understand the risks associated with synthetic implants such as silicone, Medpor and Goretex. These implants exploded in popularity between the 1970s and early 2000s, when the ease of use, short surgery times, and widespread acceptance by patients made it appealing to rhinoplasty surgeons. During the heyday of synthetic implants, silicone implants especially got inserted to hundreds of thousands of patients’ noses worldwide, often with beautiful results.
Unfortunately these results lacked permanence, as patients and surgeons experienced a number of interesting complications throughout the decades. Minor adverse events included redness and irritation of the skin over the implants, movement and migration of the implant, and infections caused by the presence of a foreign body underneath the skin. More serious complications involved the development of biofilms and chronic infections due to the implant or thinning of the skin, visibility of the implants and eventual ulceration through the skin. Patients presented with implants popping through skin along the tip of the nose, columella, septum and even along the radix and dorsum – essentially anywhere excessive tension or movement was putting stress and tension on the skin. To most patients and rhinoplasty surgeons, the rate and inevitability of eventual complications was unacceptable, and the trends towards using grafts from your own body (autologous) to minimize adverse events and maximize long-term, successful outcomes gained serious traction.
So what does the evidence and studies throughout the years have to say about the safety and reliability of costal cartilage in rhinoplasty? Multiple high-quality systematic reviews have found exceptionally low long-term resorption rates (0.22% in 1,702 cases in a 2015 study published in JAMA Facial Plastic Surgery) and high long-term graft stability. Histologic studies of costal cartilage grafts and diced cartilage fascia (DCF) grafts removed years after initial placement during revision rhinoplasty procedures have demonstrated persistent viability and stability, providing evidence of the complete and permanent integration of these rib cartilage grafts into the nose. One aspect that can’t be ignored with relation to long-term resorption rates remains the manner in which cartilage grafts are prepared and handled. When cartilage grafts are carved with scalpels and razors with sharp, clean cuts, then the viability of the chondrocytes and cells with in the cartilage is maintained. However, when the cartilage is left ex vivo for extended periods, left to dessicate or dry out prior to re-integration into the nose, or handled in a manner that crushes or kills the cells with in the cartilage, then this will negatively affect long-term viability.
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