Rhinoplasty Augmentation
When additional structural support is needed for aesthetic or functional reasons, augmentation rhinoplasty comes into play. It simply means the addition of some other material to extend the tip of the nose or offer internal support to the airways. Usually this procedure is performed to increase the projection of the nose, resulting in a more pleasing profile. It can also correct congenital defects, defects as a result of disease or accidents, or in revision surgery to correct a bad nose job.There are a number of materials available to the surgeon. Most prefer to use autologus tissue instead of the man made materials that are lso available. Simply put, autologus just means using the patient's own tissue. Cartilage can be harvested from the nasal septum, the ears, or irradiated rib cartilage can be used. Bone can also be harvested and used when additional support is needed.
Using one's own tissue decreases the chance of infection or rejection of the grafts. The surgeon will want to use something that is easily harvested, and that will remain stable over time. It should also be reasonably easy to shape.
Man made grafts also have advantages. The more commonly used ones are silicone and porous polyethylene. These materials are easy to obtain and can be shaped into almost any configuration. These materials are also unlikely to warp and have a low incidence of resorption, and no donor site morbidity. Despite this, there is also a higher incidence of infection and rejection. The patient may have permanent effects on the surrounding tissue if the graft is rejected. Many patients who need augmentation rhinoplasty have undergone extensive surgery or trauma. Nasal obstruction is often present as well. Nasal bones may have collapsed due to trauma or over resection in a previous surgery. Supporting collapsed airways may require spreader grafts. Correcting the tip requires structural grafts, while contour irregularities may be corrected using cartilage grafts. Grafts may be put into two categories, structural and contour grafts. If the nasal structure is very weak, bone grafts are also used.
They can be harvested from the ribs, ilia, or ulna. They don't often warp, but can sometimes look less natural due to sharp edges.
A thorough exam and work up should be done prior to the surgery and any allergies, previous procedures, and structural problems should be noted. Augmentation rhinoplasty can be used in a variety of situations and has been done since the early 1900's. While the reasons for the surgery are the same, many advances have been made to achieve a more permanent and natural result.
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