The cornerstone of a successful primary and secondary rhinoplasty is the reconstruction of the osseocartilaginous framework of the nose. Despite the fact that septal cartilage is the best grafting material for rhinoplasty, severe abnormalities or a lack of septal cartilage necessitate the use of alternate sources. This is especially evident in secondary or revision rhinoplasty, where earlier surgeries have left the nose structurally deformed and often functionally suboptimal.
Cartilage grafts are used for:
– Reconstruction or strengthening the septum which acts as the pilar of the nose
– Spreader grafts to correct the collapsed internal valves and smoothen out the sides of the nose where cartilage and bones join
– Lower lateral and tip cartilages to correct a suboptimal or weak external valve drastically improving breathing
– Rim grafts to prevent or correct alar notching
– And various camouflage grafts, for dorsum, key-stone area (where cartilage and bones join on the dorsum) or for tip
– Dorsal augmentation grafts (usually diced cartilage wrapped in facia or Surgicel) to augment the dorsum
– Tip support such as Septal extension grafts, columella strut or Teo strut.
Here Dr. Shahram can be seen preparing the cartilages on the table which will be used for structural support and augmentation of the severely damaged nose in a revision case. Cartilages are harvested usually from the septum in primary cases but in this case most of the septal cartilage was severed so in such case rib cartilage is used and carved into pieces which will be used to reconstruct the form and function of the nose. Occasionally ear cartilage is used for augmentation.
Prior to grafting, the nose is prepared to evaluate what is needed and to fix the grafts easily in place.
Revision or secondary rhinoplasty is a special and distinct category in rhinoplasty. It needs special skills and experience of the surgeon. Not all rhinoplasty surgeons deal with revisions. Dr. Shahram has developed the knowledge, skills and experience needed in challenging cases of revision rhinoplasties over the decades and has performed many successful revision rhinoplasties, correcting the shape and function of the nose.
