Board Certifications: American Board of Facial Plastic and
Reconstructive Surgery American Board of Otolaryngology - ABO

Grafts in Rhinoplasty

Grafts can be used to accomplish a variety of things during rhinoplasty. They are useful in narrowing or improving the projection of the nasal tip, lessening excess curvature, providing definition and support, widening the nostrils and for many other purposes.

Read on to learn more about the types of rhinoplasty grafts Dr. Rizk uses and what he uses them for.

Types of Grafts Dr. Rizk Uses in Rhinoplasty

There are a number of types of grafts used in rhinoplasty. Here are some of the grafts Dr. Rizk uses most often.

Alar Batten Grafts. Alar Batten Grafts are often used to prevent or correct nasal valve collapse, namely when the collapse is caused by weakness in the nasal sidewall. (A collapsed nasal sidewall causes narrowing of the nasal valve, which can potentially lead to breathing problems.) They can also be used to prevent alar retraction or to correct a “pinched” appearance. Alar batten grafts are often used in combination with a septoplasty or septorhinoplasty procedure. They are placed just above the lower lateral cartilages. They may be harvested from the septum or ear, but Dr. Rizk prefers to use septal cartilage grafts because they are stronger. Contact Dr. Rizk to learn more.

Spreader Grafts. Spreader grafts can be a good choice when the middle portion of the patient’s nose is too narrow, which can make it difficult to breathe through the nose. They can also be used to keep the septum straight, and are sometimes used in revision rhinoplasty procedures. Many rhinoplasty specialists believe spreader grafts should only be used in the most extreme cases, in part because they can make the nose a little bit (but noticeably) wider. Spreader grafts add width to the middle vault of the nose and open up the valve area. They are typically placed between the septum and upper lateral cartilage. Depending on the procedure, they may be placed through an open approach or an endonasal approach.

Onlay Grafts & Umbrella Grafts. These grafts are often used in rhinoplasty techniques focusing on tip support. Onlay grafts project the nose’s “dome” while umbrella grafts are used in under-projected nasal tips.

Which Graft Materials Does Dr. Rizk Prefer?

Whenever possible, Dr. Rizk prefers to use cartilage harvested from the patient’s own septum or ears. It’s a good idea to use the patient’s own cartilage because there is a much better chance that it will be well-tolerated by the body.

If necessary Dr. Rizk will use a synthetic graft called Medpor for support or definition.

He also uses irradiated cartilage (harvested from a cadaver) in some cases, especially in revision rhinoplasty procedures in which the nasal framework needs to be reconstructed. Irradiated cartilage becomes necessary when ear cartilage won’t suffice (because stronger cartilage is needed) and the patient has no extra septal cartilage to harvest. It is particularly useful for supporting the nasal tip when a stiff, flat piece of cartilage is needed.

It should also be noted that there are types of grafts Dr. Rizk does not like to use. For example, he never uses silicone grafts. He also avoids using grafts from a patient’s own rib due to: potential scarring; the risk of damage to the lung and/or pleura (the tissue that surrounds the lung); and the risk that this type of graft may dissolve.

How Does Dr. Rizk Use Grafts in Rhinoplasty Procedures?

Dr. Rizk uses grafts for a number of different rhinoplasty techniques. Here are some of the things grafts can be used for during rhinoplasty.

Tip refinement. Just about any alteration to the nasal tip compromises its support structure. If tip support is weakened, it is often necessary to perform tip refinement to provide added support with cartilage grafts.

Alar base reduction. An alar base reduction is a technique used during primary or revision rhinoplasty to correct nostrils that are too wide. It often involves the use of a cartilage graft.

Correcting a bump. If a bump looks large as a result of a pronounced depression between the eyes, a graft can be used to fill the depression, thereby eliminating the bump.

Revision rhinoplasty. Grafts are very often needed during revision rhinoplasty to strengthen and rebuild the nose. Spreader grafts, nasal batten grafts and composite grafts are some of the types of grafts used during revision rhinoplasty.

Broken nose. A broken nose may require cartilage grafting. For example, spreader grafts may be used to strengthen the existing cartilage and/or to align the midline of the nose and teeth.

Functional rhinoplasty. A functional rhinoplasty is a nose surgery performed in order to improve breathing. This may involve spreader grafts for internal valve narrowing or other techniques to correct external valve collapse.

Internal/external valve collapse and stenosis. Internal valve collapse can be treated by putting strips of cartilage in the collapsed section, or by reattaching cartilage to the septum.

To learn more about Dr. Rizk’s use of grafts in rhinoplasty, contact our office today.

Written by Dr. Sam Rizk

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