Using cartilage in Revision Rhinoplasty

We have to see what type of cartilage a patient has before we do surgery.  That’s why it is nice when we hear from our patients, especially if we don’t have the operation reports, to find out if they have had an aggressive septoplasty.

We like to know if they have septo cartilage left inside the nose.  You have to leave a certain amount of cartilage inside, at least 10 to 15 mm of cartilage, at the roof of the nose, called the anterior septum.  And we are also looking for the proper amount on cartilage at the front of the nose where the columella is called the columella or caldul septum. 

So, the first thing to do is to check to see the amount of cartilage a patient has left.   Sometimes it is very hard to assess this in the examining room.  Often we can’t get a great exam of the nose because the area can be tender. 

We’ll look at a patient’s ears and sometimes, if we need complete nasal reconstruction without building up the dorsum or dorsal height, we can use cartilage from both ears, with out having to go to rib cartilage.  This is assuming that we have no septo cartilage. 

So in this situation, the incision for harvesting ear cartilage in most scenarios is behind the ear.  The scar heals beautifully, and you do have a cotton bolster on both sides of the ear for the first week which can be a little uncomfortable.  The cotton bolster prevents a hematoma, which is a collection of blood, in between the two flaps of the ear. 

After removing some of the ear cartilage the ear will sit back closer to your head.  That is why we want to closely inspect the patient’s ear.  If we are only going to use one ear, we want to make sure to choose the one that sits out further. 

After removing the cartilage, the stitches are placed behind the ear and dissolve on their own.  The suturing we put in when we remove fascia is the same, we don’t even take them out, they dissolve.  It takes about an average of about 30 days.