Building up the bridge line or dorsum of the nose is known as dorsal augmentation rhinoplasty. This is most commonly done in ethnic rhinoplasties (Asian and African-American patients) as well as reconstruction of saddle nose deformities from trauma or prior over-resected rhinoplasty surgeries. Usually a fair amount of volume (length and height) is needed for a visible change in the dorsal line of the nose. Where does the material come from to fill this need?
Traditionally, one has to choose between natural tissue from the patient (rib or bone graft) or a synthetic implant. These two choices are dramatically different with their own distinct advantages and disadvantages. Bone or rib grafts provide a nice structural graft but that requires a harvest site (which is painful) and time to properly shape and secure the graft in place. Synthetic implants offer an easy off-the-shelf graft which saves having a painful donor site and is easy to shape but such implants have significant long-term issues of migration, infection, skin thinning, and potential exposure. (I suspect that the long-term complication rate of synthetic implants in the nose is much higher than is reported….and most will eventually need to be removed)
An alternative graft approach, championed by Rollin Daniel in Newport California and reported in the December 2008 issue of Plastic and Reconstructive Surgery, is that of diced cartilage wrapped in temporalis fascia. Using bits and pieces of cartilage from the septum, ear, or even rib which are chopped into fine pieces, they are packed into a syringe and injected into a wrap of harvested fascia from just above the ear. This wrapped cartilage method produces a nice ‘moldable piece of clay, which can then be inserted onto the bridge of the nose. This natural cartilage method has the advantage of being less labor intensive than harvesting rib or bone grafts, uses small or scrap pieces of cartilage, and is very moldable once in place on the nose. Because it is your own cartilage, it becomes a living and unified piece of cartilage over time.
Having used this method recently, It appears to be a valuable option for grafting the nose. Some of the classic problems with larger structural grafts of rib or bone, such as warping and the need to secure it into place, are avoided. This is actually a fairly old technique of cartilage grafting that dates back more than 50 years ago. But what is old…..is new again.