The concept of a non-surgical rhinoplasty or nosejob has emerged with the popularity and widespread use of injectable fillers. For select nasal defects, most commonly to camouflage a small nasal hump, fillers are introduced by needle through the skin to get an immediate result. While it is not permanent, the use of longer lasting fillers can get results from this type of ‘rhinoplasty’ that may last six months or longer. The most common fillers used for this injectable rhinoplasty is that of Radiesse, although any filler composition may be used.
The appeal of this needle approach is that it is not surgery and gets an immediate effect with no recovery. But it is not permanent and the cost to maintain the result over time will eventually exceed that of a surgical rhinoplasty.
There is, however, an alternative to this injectable rhinoplasty that can be permanent and involves no synthetic materials. It is more than an office injectable treatment but short of doing a more formal open rhinoplasty. Using your own cartilage, small nasal defects can be treated by injection.
Diced cartilage is a well known method of cartilage grafting to the nose. Solid pieces of cartilage are cut into very small pieces, wrapped in surgicell or fascia, and then inserted as a flexible sausage-like graft. It is easily moldeable, even after surgery, and the cartilage is quickly revascularized and ingrown by native tissues. It has a near 100% percent volume survival.
A modification of diced cartilage nasal grafting is to convert it into an injectable technique. For small cartilage-deficient defects in the nose, it is not necessary to wrap it in a sleeve for introduction. The size of the pocket controls where the graft stays. It is introduced through an endonasal approach as opposed to a percutaneous needle method.
A septal cartilage graft is diced into very small pieces (1 x 1mm) or even smaller and then placed into a 1cc syringe for introduction. The size of the defect is measured by laying the syringe along side the defect and doing a volumetric assessment by pulling back on the plunger. The open end of the syringe is cut flush and then packed with the diced cartilage up to the measured pullback of the plunger. Small quantities of cartilage of .1 to .2cc can easily be delivered.
Through an intercartilagenous incision inside the nose, a narrow pocket for the pathway of the syringe is made up to the location of the defect. The graft is then injected and molded externally. It is then externally taped for up to a week until the graft is completely adherent and immoveable.
Even smaller quantities of diced cartilage (less than .05 to .1cc) can be injected through a smaller introducer. Using a 7 French suction catheter, the end can similarly be packed and then extruded once into position by the stylet that is usually used to clean it.
This injectable rhinoplasty technique for diced cartilage is especially effective for dorsal augmentation. It can be used to primarily augment above a small hump or correct any irregularities from dorsal osteotomies or fractures. The key to success with injectable cartilage rhinoplasty is a precise tunneling technique and pocket control. It is important to keep the graft confined to the exact area of the cartilage deficiency.
This method of injectable rhinoplasty using one’s own cartilage may be a better long-term choice than the repetitive use of injectable fillers for small nasal defects.
Dr. Barry Eppley
Indianapolis, Indiana