Even after being a practice for decades Rhinoplasty remains the most challenging of plastic surgeries of all times. Rhinoplasty presents a challenge for both the patients as well as the surgeon as both try to match the expectations of what is considered to be the ‘perfect’ nose. There are many aspects to Rhinoplasty which including using various techniques to reshape and augment the nose to suit the facial symmetry of the patient.
The most complex part of Rhinoplasty is augmenting the dorsum of the nose. The dorsum has to be the correct height, the correct width and still be able to ensure the proper functioning of the nose with ease and provide adequate support. Rhinoplasty using diced cartilage in Fascia is the technique that is used to reshape the dorsum to the desired level so that it looks as close to natural as possible. Use of cartilage in Rhinoplasty is one of the top techniques that are used to make the nose look as if it has never been operated on and still improve in looks and functionality.
The use of cartilage in Rhinoplasty has been in practice since the 1950s. Both autogenous and synthetic grafts are used in rhinoplasty but using diced cartilage wrapped in Fascia used the patient’s own grafts and therefore becoming more and more popular nowadays.
Development of the Technique
Use of cartilage was first published in the 1941 Young and Peer who used this technique to reconstruct an ear. Widely popular this method caught the eye of the neurosurgeon and other surgeons to reconstruct other facial features such as the part of the forehead and face. However it was in the 1990s when the technique of rhinoplasty using diced cartilage in fascia was extensively studied and proven to be very successful.
Today the used of diced cartilage in fascia is used in both primary and secondary Rhinoplasty surgeries.
Rhinoplasty using diced cartilage wrapped in fascia:
Cartilage in Rhinoplasty requires the work of an expert surgeon who can harvest the right amount of cartilage from the patient’s body, cut it and shape it to give the dorsum the shape it deserves. The biggest advantage of diced cartilage is that they are highly flexible and can be used throughout the nose. This process is especially helpful in patients with radix grafts. People who have a saddle hump kind of nose can easily get a natural looking even nose with use of cartilages.
In this method the surgeon takes the cartilage from other parts of the body and warps it tightly in the fascia or covers the cartilage with fascia (depending on the patient’s requirement) and places it in such a way that it augments the nose in a natural way. Vis a Vis the use of just cartilage the use of cartilage with fascia gives a firmer hold to the cartilage and gives a better shape. Also sometimes in cartilages there is a chance of edges being visible especially with thin skinned people however with this technique this problem can be easily contained. A proper evaluation is to be done by the surgeon to determine the correction needed.
However the problem rhinoplasty using diced cartilage in fascia is that there is a chance of scarring and infection at the place the graft is taken from. Also the process takes a longer time and therefore the cost is on the higher side. On the other hand the advantages of use of cartilages in rhinoplasty far outweigh the advantages. Diced cartilage in fascia reduces the chances of warping, misalignment and extrusion. Also these grafts are simpler to use and give superior results. Being an auto graft there is not risk of rejection and infection in the patient’s body.
The difficulty of dorsum reconstruction is easily overcome with the technique of rhinoplasty using diced cartilage in fascia. This process is safe and can be used for nasal augmentation with minimal risks.