Augmentation Rhinoplasty - Implant vs. Cartilage Grafts

Rhinoplasty in certain ethnic groups, such as African-Americans, Asians, and some Hispanics, may often involve building up the bridge of the nose. (dorsal augmentation) Because the bridge of the nose is long and often requires a fair amount of thickness to have a visible effect, the use of a preshaped implant is often chosen over using one’s own tissues. (bone or cartilage) This has tremendous appeal to the patient as the use of an implant does not require a painful donor site, is easier to do (less time in the operating room), and the results are immediate and permanent.

For these reasons, patients often prefer a synthetic implant over harvesting their own tissues. For me, this is a tough decision as both options, implant vs. your own tissue, are not perfect and each has its own set of ‘problems’. It is true that a nasal implant provides an immediate and easy solution in augmentation rhinoplasty. It is one of the reasons that, in the Pacific Rim, the ‘lunchtime rhinoplasty’ involves the insertion of a nasal implant under local anesthesia and is by far the most commonly form of rhinoplasty in that part of the world. However, there are long-term issues with a nasal implant which primarily is the risk of thinning of the nasal skin (due to pressure) and eventual exposure of the implant. While not common, and no one knows the real lifelong risk (how often does it happen?), this is tantamount to a rhinoplasty disaster. Usually this is avoided if the nasal implant is not too big and is placed properly. Conversely, the long-term effects of cartilage or bone grafting, while not perfect (some of the graft may resorb or warp), do not involve this kind of disastrous problem. Cartilage and bone grafting of the nose, when the graft requirements are substantial, involve a lot of work up front but don’t have the same potential for long-term major problems.

This is a rhinoplasty controversy in which there is no straightforward answer for some patients As I often tell patients, it just depends on which side of the equation you want to take your risks. A short-term fix (nasal implants) with the risk of a long-term problem or a long-term fix (bone/cartilage grafts) with the risks of short-term problems. (donor site pain, longer operation and recovery) These issues become further muddled, or actually clearer, when one looks at the economics of both. A augmentation rhinoplasty using your own tissues is going to be more costly….but it may be a good price to pay in the long run.

Dr Barry Eppley

http://www.eplpeyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis