By ENT-Plastic Surgeon Dr.K.O.Paulose F.R.C.S(Fellow of the Royal College of Surgeons UK)
Consultant ENT Surgeon Jubilee Hospital, Trivandrum, Kerala, South India
Introduction
The nose is located in the central part of the face and also the most prominent structure, so any small deformity is easily visible. Therefore it is not surprising that nasal surgery or rhinoplasty is performed so often. Nevertheless, rhinoplasty is a significantly satisfactory procedure that helps individuals achieves greater self- esteem and personal satisfaction.
Rhinoplasty is a type of cosmetic surgery that is performed in order to reshape the nose. Although rhinoplasty is most often sought for cosmetic reasons, it can also help correct structural defects that may cause breathing problems.
The indication for rhinoplasty is a particularly difficult problem, and the surgeon carries a huge responsibility for refusing or accepting the request. It is an easy operation to do, but it is hard to get good results.
There are two approaches for Septo rhinoplasty, the endonasal approach and the external approach, I prefer the later.
Who can do Rhinoplasty-ENT or Plastic surgeon?
With the modernization of society demand of cosmetic value has been increasing. In majority of centers rhinoplasty is done by plastic surgeons and general people have the concept that this is the work of plastic surgeons. But an ENT surgeon who had been trained to do plastic surgical procedures is the best person to carry out the Rhinoplasty. Moreover, only the ENT surgeon can solve the functional and structural aspects of the nasal deformities like the septum, turbinates etc.
Augmentation Rhinoplasty
Rhinoplasty may require the addition of material to augment the nose. Augmentation is necessary for both aesthetic and functional indications. Functional reasons for augmentation include providing structural support for areas deficient of material, such as the upper or lower lateral cartilages. Augmentation may also be required for aesthetic reasons. Typically, augmentation rhinoplasty is performed to increase the projection of the nasal dorsum on the profile view. The nasal tip may also be augmented. In addition, grafts may be placed to camouflage irregularities of the bony dorsum and of the upper or lower lateral cartilages.
A number of materials are available to the Rhinoplastic surgeon to augment the nose. These include
and Alloplasts (synthetic implants),
and Allogenous materials (obtained from cadavers), or
and Autologous implants (harvested from the patient’s own tissue).
Many surgeons prefer to use autologous tissue whenever possible, and some evidence suggests a lower incidence of infection when the patient’s own tissue is used. Autologous materials have the potential to be incorporated into the host tissue bed, offering stability, as well as resistance to infection and extrusion over time.
Autologous materials are also believed to have the unique ability to adapt to the host bed. Thus, a graft consisting of cartilage tends to fix well to cartilage, and bone tends to fix well to bone.
Autologous materials used include cartilage and bone; examples include septal, auricular, and costal cartilages as well as costal or calvarial bone.
Cartilage grafts-Septal, Conchal , Tragal cartilage
One of the advantages of septal cartilage is the ease of harvest from the surgical field. Septal cartilage tends to be well suited for augmentation rhinoplasty.
A relative disadvantage is that an adequate amount of septal cartilage is often not available for moderate-to-severe augmentation in patients who have undergone previous septorhinoplasty. This shortcoming is due to resection of septal cartilage at the time of previous surgery or the resorption of the residual septal cartilage over time.
Auricular cartilage is easily harvested and generally sufficient for mild-to-moderate augmentation. However, auricular cartilage has a tendency to warp or crack, with efforts to soften or crush the edges. This donor cartilage can also be difficult to use in persons who need a straight graft (eg, columellar strut). Conchal graft is taken by anterior approach, make sure the incision is just below the trim of concha cavum.Hydrodisectiion and meticulous elevation of the flaps give a good intact graft. If you need one can take graft from both side and use sandwhich technique.A bolster dressing is sutured in place to avoid haematoma.
Tragal cartilage– Easy to take and good for collumellar strut.No scars and easy access.
Procedure- as shown in pictures above
Please make sure take the graft from not dominant ear –using phone or sleeping on same side.
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