Grafting Techniques in Rhinoplasty
Grafts may be used during rhinoplasty surgery to provide shape and support to the nose. They can help to widen or lengthen the nose, refine the nasal tip, or change the nasal projection or nasolabial angle. They may be used during primary rhinoplasty to support weak cartilages and prevent collapse, to straighten the nose, or to add definition to the nose in patients of ethnicity or those with thick skin. Grafts are also commonly used during revision rhinoplasty to replace missing tissue and correct or prevent collapse.
Grafts can be made from a variety of materials. In general, those made from natural materials are preferred. Cartilage can be taken from the patient’s nasal septum or from the ear for use as a graft. Cartilage can also be taken from the patient’s ribs if necessary. There are many different types of grafts which can be used for a variety of purposes. Some of the more common ones used during rhinoplasty include the following:
- Alar Batten Grafts – Alar batten grafts are commonly used to help prevent ala retraction and ala collapse. They can also support the nose in areas where cartilage is deficient and they can help to support the nasal airway. Alar batten grafts are commonly used during revision rhinoplasty to correct a pinched nasal tip. These grafts are usually made from septal or rib cartilage. Ear cartilage is often less desirable as it tends to be softer and more pliable.
- Alar Rim Grafts – These grafts are often used to improve the triangularity of the nose as well as to improve retracted nostrils or a pinched tip. Softer ear cartilage is often preferred for this graft in order to prevent a stiff appearance.
- Caudal Extension Grafts – Caudal extension grafts can add size to the septum. They can also add length to the nose to make a short nose longer, treat deviation of the nose, adjust the nasal projection, and help to position the tip and hold it in place. These grafts may be made of septal, ear or rib cartilage and they may be placed using an open or closed technique.
- Columellar Struts – Columellar struts are often used in the nasal tip to provide support to a weak tip or increase projection. They can be placed using either an open or closed technique. The one drawback is that they are free-floating and not attached to the septum, making them less predictable than other types of grafts.
- Composite Grafts – Comprised of two materials, usually skin and cartilage obtained from the ear, composite grafts can be used to correct a retracted ala.
- Dorsal Augmentation Grafts – Dorsal augmentation grafts are used to augment the nasal dorsum, often to correct a scooped appearance also known as a saddle nose deformity. Septal cartilage is typically preferred and rib cartilage may be used as well. Ear cartilage is generally less desirable here.
- Lateral Crural Strut Grafts – These grafts are typically used to reshape or reposition the lower lateral cartilage and they may be helpful in fixing cartilage that is overly concave.
- Onlay Grafts – Onlay grafts are those which are placed over or on top of an area. They are often used to augment areas deficient in cartilage where a depression may be present. There are different types of onlay grafts. Tip onlay grafts can be used to add definition and projection to the nasal tip and they are often made from ear cartilage. Camouflage grafts are another type of onlay graft and they may be used to correct collapsed or indented areas in the nose.
- Plumping Grafts – Plumping grafts can be placed at the nasolabial angle, they can be used to improve a retracted columella, and they can be used to make the nose look shorter.
- Radix Grafts – Radix grafts are placed at the nasofrontal angle (the area where the nose meets the forehead) in order to alter the angle so that it is not too deep and the dorsum does not sit too low on the face. This type of graft can create a longer, more elegant appearance to the nose. Crushed cartilage is often used to make the graft less visible.
- Shield Grafts – Shield grafts are so named because they are similar in shape to a shield. They can improve projection and add definition and some support to the nasal tip.
- Spreader Grafts – Spreader grafts are used to widen the middle vault of the nose and are useful in correcting an inverted V-deformity or a narrow middle portion of the nose. In appropriate patients spreader grafts can also help to open up the internal valve and improve the breathing function. These grafts can be placed using an open or closed technique.