How often can the ear be used for cartilage? Asian patient, no septal cartilage to use.

Posted on March 21, 2017 by Donald B. Yoo, M.D.

Q: I’ve already had the back of my ear used for one failed rhinoplasty. I need to get it right this time. I need dorsal augmentation, tip support, definition & slight rotation/projection. I feel building up my bridge w/anything more rigid will make me look masculine (I am female & want a short but straight nose). Where can the ear be mined for tip-suitable cartilage?

A: With cartilage from your septum and one ear already exhausted, it is unlikely the other ear will provide enough cartilage to provide dorsal augmentation, tip support, and counter-rotation + projection.  Rib cartilage provides a large volume of strong, straight cartilage for structural grafts (extended spreader grafts, septal extension graft) for tip projection/counter-rotation.

For dorsal augmentation, I feel the diced cartilage fascia (DCF) technique is the best option as it provides the most natural looking and attractive contours in a permanent fashion.

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If I don’t want a drastic change when removing the implant, will reducing the implant height work?

Posted on March 21, 2017 by Donald B. Yoo, M.D.

Q: If I don’t want a drastic change when removing the implant of (2-3 mm silicone), do you think reducing the implant height in several attempts (once every year) will work? I’m always paranoid of people looking at my nose and I made determination to remove it someday

A: I would not recommend trying to reduce the height of the silicone implant, and certainly not yearly, as this will introduce more scar tissue to your nose and further impair the viability of the skin.

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Visibly lumpy bridge after Asian rhinoplasty – Can ear cartilage grafts (Asian rhinoplasty) be removed?

Posted on March 21, 2017 by Donald B. Yoo, M.D.

Q: Had an Asian rhinoplasty 9 months ago, and had ear cartilage grafts put in the bridge (radix area). After swelling went away, the graft is very visible and you can clearly see and feel the edges. From a distance, it looks like a bump. No fascia was used to wrap the graft, an intact (not crushed/diced) piece approx 4-5 mm long. Do I have to wait up to a year since my surgery to get a revision, or is this something that can be fixed now in a simple procedure? Could the graft resorb on its own?

A: Removing an onlay graft on your bridge can safely be performed at any point after surgery (and especially at 9 months post-op this will not create any increased risk).  The ear cartilage graft is unlikely to resorb on its own.  The question is whether or not you will be satisfied with the appearance of your bridge and radix without anything to augment that area.

One of the great strengths of the diced cartilage fascia (DCF) technique for radix and dorsal augmentation is that when performed well it creates the smoothest, most natural contour.  At 9 months post-op, you could safely undergo a revision to remove the visible cartilage graft and replace it with a DCF graft.

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3 weeks post op Asian nose job. Will it be pointy and grow a longer as time goes by?

Posted on March 21, 2017 by Donald B. Yoo, M.D.

Q: It’s been almost 2 weeks since they took off my nose splint (3 weeks since the day I got a surgery). I feel like the tip of my nose is kind of round, big and short. Will it be kind of pointy and grow a little longer as time goes by? p.s: they used my ear cartilage

A: Swelling of the tip of the nose 3 weeks after rhinoplasty is expected and completely normal.  While your profile should begin to look good at 3-4 weeks after surgery, the majority of the tip edema (swelling) will not resolve for 3-6 months.  At that point you will be able to tell whether or not the initial surgery provided enough tip support and refinement to achieve the results you were hoping for.

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What are the risks of using your own diced rib cartilage wrapped around your own fascia?

Posted on March 21, 2017 by Donald B. Yoo, M.D.

Q: 1. What are the risks of using your own diced rib cartilage wrapped around your own fascia? 2. How do you make decisions to use either diced or whole rib cartilage for the bridge augmentation? 3. Heard rib cartilage could warp over time when used for the bridge. What is/are alternative(s) other than using foreign materials? 4. Have Gore-tex for my nose. It fell on the right side of my face and made my nostrils look uneven. Is this an emergency? Would this change my bone/skin structure?

A: The diced cartilage fascia technique does require special expertise and a great deal of experienced to create consistent, predictable results.  The most commonly encountered issue is contour irregularities and asymmetries – as with any technique for dorsal augmentation.  In skilled hands, the diced cartilage fascia technique provides permanent, natural and attractive results, but in inexperienced hands can be unpredictable and inconsistent.

Diced cartilage fascia provides permanent results without the risk of warping or resorption of en bloc rib cartilage, and with a much lower rate of migration, infection, or extrusion than synthetic grafts.

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Is it a safe method to use goretex placed in to the bridge of your nose, and ear cartilage on the tip?

Posted on March 11, 2017 by Donald B. Yoo, M.D.

Q: Hi I had my rhinoplasty done for 15 days now. My surgeon used goretex at my bridge and ear cartilage with my tip. I was not aware that the first option and much safer if full cartilage graft. I am worrying now for the future infections or rejection.

A: While Gore-tex and other synthetic implants have a higher rate of complications than using tissue from your own body, you are certainly not at any immediate risk.  While there is a higher risk of infection and extrusion – infections can typically be treated with antibiotics and extrusion is more of a long-term issue.

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I am an Asian revision rhinoplasty patient. Can my septum become deviated and weakened if I allow it to be harvested for grafts?

Posted on March 11, 2017 by Donald B. Yoo, M.D.

Q: My septum’s always been a little deviated & I worry it is a little deviated after a trauma. I noticed the most change after a 2nd revision. In primary, I had a rhinoplasty that elevated my tip/nostrils. I was hit very hard in the tip (no bones broken), but now, after a 2nd procedure that involved harvesting a single shield graft, the nasal tip was lowered. The right side was harvested for material. My left nostril now seems closed. I want to raise my tip again. What am I at risk of now?

A: During Asian rhinoplasty, the septum can serve as a good source of cartilage to create structural grafts to reshape the nose.  It is important to preserve enough cartilage in the native septum to allow for normal strength and structural integrity.

If septal cartilage has been previously harvested, then many times it is a better option to obtain cartilage from a different donor site (ear cartilage vs. rib cartilage).  The degree of change you are hoping to achieve will dictate the best cartilage source – and this is best determined after an in-person consultation with an Asian Rhinoplasty Specialist experienced with revision rhinoplasty.

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Extremely red tip after Asian rhinoplasty with cartilage grafting – normal part of the healing process?

Posted on March 11, 2017 by Donald B. Yoo, M.D.

Q: I had Asian septo-rhinoplasty 3 days ago, with ear cartilage grafts to the tip. This is my first rhinoplasty. Today, I noticed my tip has gotten very red. I have not touched the tip at all and have been keeping up with my antibiotics. It was not red after the procedure and it only became red today – I know it’s only been three days, but is this a normal part of the healing process? Thanks!

A: It would be unusual to develop an infection that early after rhinoplasty, and the redness is likely more a product of the tension exerted on your nasal tip skin by the underlying grafts.  However, it is always prudent to inform your surgeon of any concerns and to follow up closely with him/her to ensure the best results.

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I had a Medpor strut graft removed and now my breathing is worse. Can I replace it?

Posted on March 11, 2017 by Donald B. Yoo, M.D.

Q: I am a thick skinned, wide-nosed Asian patient that had Medpor bilateral strut graft & ear cartilage in my middle nose in a functional & aesthetic rhinoplasty. It narrowed my nose & helped me breath through both nostrils really well. I had it removed based on bad medical advice, am breathing poorly now & feel I need a similar structure in my nose. So long as I have scar tissue removed in revision, can’t I have the implant replaced w/ear? Why should I go through harvesting so much cartilage?

A: Medpor is inferior in the nose relative to autologous grafts (tissue from your own body) for many reasons, not least of which is its higher rate of complications.  Ear cartilage is great for contour grafting, but is at times too flimsy to provide adequate structural grafting.

One misconception of cartilage grafts is that it prolongs recovery after rhinoplasty.  It actually does not prolong it at all because during the week you have a cast and sutures on your nose, your donor site is also healing.  The cast and sutures on your nose and donor site are all removed together at one week, and thus everything heals together and recovery is not lengthened one bit.

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What Asian nose surgery would you recommend?

Posted on March 10, 2017 by Donald B. Yoo, M.D.

Q: I’m from India, but we are tribal so I have a very flat nose. I’m very uncomfortable using my spectacles and shades. Please suggest what kind of nose job will be best for me.

A: You will need to add volume to adequately build up the bridge of your nose (dorsal augmentation).  Based on the degree of change you’re trying to achieve, this could be accomplished with cartilage from inside your nose (septum) and cartilage from both ears, or cartilage from one of your ribs.

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