The Internet can be a powerful tool for information and it is a good thing that more and more consumers are educating themselves about plastic surgery. And, a cartilage graft is no exception. Patients often express concern about the use of cartilage grafts and typically say something like: "I read on the Internet where cartilage grafts can become visible and I was told they should be avoided." While it is true that cartilage grafts may become visible, particularly in patients with more transparent skin, it does not mean that cartilage grafts should be avoided. In fact, cartilage grafting is an essential tool for both primary and revision rhinoplasty. Various types of cartilage grafts are commonly used by virtually all accomplished rhinoplasty surgeons.
Many patients present with a weak nasal tip framework, leading to an unattractive, drooping tip. Cartilage grafts make it possible to strengthen the tip and provide support. Without the ability to reshape the nasal tip framework, the results would be less than optimal. In many noses, there may not be enough natural strength or available tissue to reshape the existing framework. These deficiencies are generally found in the previously operated nose, where much of the nasal skeleton may be missing and the remaining tissue is often severely damaged. Because further tissue removal will only exacerbate the deformity, the outer nasal framework must be rebuilt with a mosaic of fabricated parts, carved from donor cartilage. The new nasal framework is structurally engineered to ensure that the desired shape is maintained over time. A grafted structure is also artistically designed for symmetry, proportion, and a contour that harmonizes with the surrounding features and lends beauty to the face. This form of "living sculpture" is unique to cosmetic nasal surgery and requires a combination of artistry, experience and surgical ability. Moreover, even when cartilage grafts are skilfully performed and properly secured, deformational forces such as wound contracture, skin fibrosis and cartilage warping can spoil an otherwise satisfactory outcome.
Although cartilage grafting is far from easy, and often made more difficult by cartilage in poor condition grafting is without question the single most important tool in contemporary rhinoplasty. Without it, only a small minority of patients could achieve satisfactory cosmetic results.
