One of the most common questions I get asked during rhinoplasty consultation relates to how the nasal bridge (or dorsum) can be augmented or elevated. Different surgeons prefer different methods based on what works best in their hands. My preference is to use the patient’s own cartilage for dorsal augmentation if it is available in sufficient quantity. If only a slight amount of elevation is desired and/or there is only a short segment of the bridge to augment, cartilage taken from inside the nose (from the septum) or from the ear is generally sufficient. If there is septal cartilage present, this should be used before consideration of ear cartilage. If there is a more significant amount of augmentation desired, I may recommend you opt for costal, or rib, cartilage grafting. Rib grafting allows me to build up the bridge essentially using a single, long piece of cartilage. This method is preferred over use of several different pieces of cartilage, which increases the risk of unwanted absorption and, thus, contour irregularities. Rib cartilage can be harvested from one of your own ribs or as an alternative is provided by a tissue bank (termed cadaveric rib cartilage). When shaped with what we term is concentric carving technique, rib grafting can be done with less risk of warping and resorption.
It is worth noting in many cases of ethnic rhinoplasty (including Asian and African-American noses), the amount of septal cartilage available for harvesting is simply insufficient for bridge augmentation. In many of these ethnic noses, the amount of augmentation desired is considerable. Because of these factors, ethnic rhinoplasty often requires rib grafting to achieve the desired amount of bridge augmentation. In the rare case where a patient simply does not wish to undergo rib grafting or use cartilage from a tissue bank, we will discuss possible use of an implant, such as Goretex. In those ethnic patients with very thick skin overlying the nose, this type of material can be used with successful long-term results for bridge enhancement. However, patients must understand there is a higher risk of infection with use of Goretex and rejection of the material can occur in the future.
