Difficult rhinoplasty

Written by Escobar MD     

There are highly difficult rhinoplasty cases. They tend to be cases with several prior surgeries. A nose that is in a bad condition, with previous surgeries, will normally show that the reconstruction needs an expert surgeon and a technique that is capable of solving what was not possible previously.

There are many techniques to solve these cases nowadays. In many of these cases, given that there has been an important damage in the structure of the nose in prior surgeries, it is necessary to reconstruct what was lost or damaged.

Some surgeons use the patients' own tissues, or synthetic tissues, or a combination of both. If the patient's own tissues are used, they can be rib cartilage, septum cartilage or ear cartilage.

Personally, and due to the technique that I perform, I prefer (in a case needs a reconstruction of the support and structure of the nose) to use ear cartilage. It is strong, flexible and malleable enough to recreate most of the cartilaginous nasal structures (which are the ones that are most damaged by prior surgeries).

With a small amount of cartilage extracted from the ear, we can solve almost all the cases of nasal reconstruction derived from problems caused in prior surgeries.

It is usual for surgeons to use aggressive techniques, to remove a lot of cartilage to narrow the nose or make it pointier. This has negative aesthetic and functional consequences in long term, meaning that the nose will look bad and, to top it off, the patient will not be able to breathe well! ).

The auricular cartilage, especially from the auricular shell, is ideal to reconstruct the entire nasal tip, giving it an esthetically adequate shape again. At the same time it solves breathing problems and can solve profile defects, for example in the cases where a big nasal hump is removed. We can even also close septum perforations.

The great advantage of the use of auricular shell cartilage is that it is easy to extract, it barely leaves a scar on the ear, it has few complications (as opposed to the extraction of rib cartilage), it is easy to mold and it does not have rejection problems (as other materials can have).

To summarize, if you believe your case is difficult, you have several prior surgeries, and you are looking for a solution, ask for ear cartilage grafts; perhaps your case could be solved this way.