In cases of revision, nasal aesthetic cartilage usage surgeries, the operation technique used in the first surgery is essential. Because in the first rhinoplasty surgeries performed by removing nose ridge (The Open Roof).
At this technique, the nose’s own cartilage (Septum) is mostly used to shape the new nose back, and from another place, cartilage is needed in their revisions. However, in preservation rhinoplasty operations, enough cartilage is always left for revision surgery possibility.
In fact, in preservation rhinoplasty surgeries, the intranasal cartilage is often not touched at all or is sufficient to use a minimal amount. Despite the possibility of revision, leaving the nose’s own cartilage (Septum) is one of the essential advantages of the dorsal preservation rhinoplasty, which I generally prefer this technique.
If there is not enough cartilage in the nose and cartilage is required for structural support, we have some options, these revision nasal aesthetic cartilage usage alternative are ear cartilage, the patient’s own rib, or cadaver cartilage.
Ear cartilage can be used for more limited revisions (Minor Revision = Limitedly Retouch), but it has handicaps such as the amount is fixed and curved shape. For this reason, I prefer ear cartilage very rarely. But, rib cartilage when the need for revision nose aesthetics cartilage is in large quantities.
When it comes to using rib cartilage, we have alternatives such as using the patient’s own cartilage or cadaver cartilage. When these options come to the fore, I decide on both methods’ advantages and disadvantages by talking with the patient in detaily.
Revision nasal aesthetic cartilage usage is the biggest disadvantage of the patient’s rib because a second incision is made, and the surgery is extended by about 1 hour. For this purpose, I prefer to take this cartilage with an endoscopic approach and an average of 1.5 cm incision.
The advantage of using an endoscope herein is that it has a more limited incision and scar, as well as less damage to surrounding tissues. It offers a speedy and comfortable healing process. I also believe that the risk and complications of this method experienced hands are quite low.
In the case of revision nasal aesthetic cartilage usage, cadaveric rib cartilage is also a good option. This commercially available product is extremely safe to use with its exposure to high doses of radiation and various solutions. Besides its disadvantage that its price is high, it is the biggest advantage that there is no need for a second surgery area (donor area scar and jeopardy).
Rib cartilage usage at revision nose aesthetics has also been the first choice in my practice. Because of the long-term negative consequences such as bending and twisting very very seldomly with the new cartilage preparation methods of rib cartilage, such as oblique split carving technique, which have developed recently.
When the possibility of revision nose aesthetic cartilage usage comes to the fore, it is absolutely necessary to learn the technique of the first surgery and discuss the events in advance. If I am going to use it, I will use the patient’s rib if he/she needs a lot of cartilage.
But if I will need less cartilage, I prefer cadaver cartilage. I have been using cadaver cartilage for the past 5 years, and I am also pleased with the long term results. Also, when I talk to many colleagues, surgeons who prefer cadaver cartilage, having unanimous with me increases my confidence in this method.