Cartilage Wear After Nose Job
13 January 2021 onur
It is the cartilages and bones inside our nose that gives it the shape we see externally.
In rhinoplasty, we shape those cartilages and bones.
Nasal cartilages can be dealt with in 2 basic groups.
The first group is composed of elastic, bendable cartilages that support the tip and the side walls of the nose.
The second is the hard and durable septal cartilage that is located in the midline and divides the nose into 2 airways.
The anterior part of the septal cartilage provides structural support to the tip of the nose while the upper part supports the nasal ridge.
The posterior and base parts of the septal cartilage do not contribute much to the shape of the nose.
The transfer of a cartilage from its original place to another place is called a “cartilage graft”.
Cartilage grafts harvested from the back and base parts of the septal cartilage are used to support and reconstruct the front and upper parts of the septum as well as the soft nasal cartilage and soft tissues of the nose.
It is possible to suggest that there is no modern rhinoplasty approach where cartilage grafts are not used.
Cartilage grafts are of extra importance in structural rhinoplasty, which is my preferred surgical technique. In this technique, we return all the cartilage we take from the nose back to the nose again. Cartilage is transferred from places where it is functionally not needed to areas which desperately and functionally need that cartilage. I strongly recommend that you take a look at my blog article on my structural rhinoplasty technique.
Cartilage wear after nose job is a phenomenon that has yet to be resolved and fully understood. It is very important for rhinoplasty candidates to know this complication before surgery and to understand the potential consequences.
As a basic principle, a decrease in blood circulation occurs as soon as you dissect the cartilage from the surrounding soft tissues during a surgical operation. Surgical dissection reduces the mass, endurance and supporting strength of cartilage. In other words, even if you just open and close the nose and do not change the shape of anything during surgery, the nasal cartilage will weaken and the structural support of the nose will decrease over time. Cartilage wear as described so far is common in all rhinoplasty procedures. Any rhinoplasty weakens the nasal cartilage to some extent.
The reason why structural rhinoplasty has emerged is already associated with this phenomenon. Anticipating that the cartilage will weaken, we support them with cartilage grafts during the first surgery. Cut in beams and columns, cartilage grafts are integrated into the structure of the nose with permanent sutures. This allows us to maintain the shape of the nose in the long run.
In a small percentage of patients (1-2%) who undergo rhinoplasty, both the cartilage of the nose and the cartilage grafts we use to support the nose may lose significant volume/resistance or even completely disappear. In such a case, the nose loses its structural support, and the nose tip and nasal ridge may be positioned elsewhere than what was planned preoperatively.
It is a rare but very unpleasant condition.
It is utterly disappointing for both the patient and the doctor.
But we do not have a lot of options.
We will need to harvest cartilage from the ribs and restructure the nose with these rib cartilage grafts.
Well, it doesn’t help to be upset about why that happened to you.
Nasal cartilage wear may occur due to a clinically undetectable (subclinical) microinfection, an immune response that develops against the suture material used or some hyperactivity in an individual’s immune system. It is often impossible to find an underlying cause.
Cartilage wear after nose job is not a condition that the surgeon can prevent through experience or diligence. Any surgeon who has performed a good number of rhinoplasty procedures will sooner or later face this unfortunate situation. One of the reasons why even experienced surgeons who perform the structural technique in all their operations have a certain “revision” rate is cartilage wear, as I have mentioned in this article.
The fact that a complication is rare does not give us sufficient grounds to ignore it. A 1% probability for you means 1 or 2 actual patients I have to deal with every year. Therefore, we cover all possibilities, albeit rare, in our informed consent forms.
In all operations involving grafts, there are similar problems. Loss of vascular grafts results in the patient’s death in cardiac surgery or organ transplantation, while the loss of nerve grafts leads to loss of vision, and the loss of corneal grafts ends up with the patient suffering an injury.
It is good news in rhinoplasty that the aesthetic deformity caused by cartilage wear/graft loss can be solved through a secondary surgery, albeit demanding.
I wish you a successful surgery free of complications.
Take good care…
… of yourself and your beauty.