| 
Whenever the nose needs structure added, it requires
either a bone or cartilage graft or an implant. There are many reasons
a person may want their nose to be “built-up”. These include
congenital deformities, which may result in an uneven nose, a nose broken
through trauma that may require more support to the bony structures,
people from Asian descent who may want a stronger bridge all patients
who have a sixties “over-operated on nose”.
Whatever the reason, nasal grafting is more popular than you may think.
Sydney cosmetic plastic surgeon Dr Darryl Hodgkinson explains: “About
15% of my patients have some kind of grafting during a rhinoplasty to
get the optimal shape of the nose.”
So What Does The Surgery Entail?
Dr Hodgkinson prefers to use the patient’s own tissue to make
the graft. While there are options such as silicone implants he recommends
using bone and cartilage. “The body will have a reaction to anything
you put in that’s foreign. However, if it’s your own tissue
your body won’t have a reaction. There are also long-term problems
associated with implants and we want to avoid these in the nose because
the tissues are so thin and everything underneath will show if the skin
or lining of the nose becomes fragile with time.”
If cartilage is needed it is usually taken from the septum (cartilage
dividing the nostrils) or behind the ear. This ensures the scars are
well hidden. “I usually try to take the cartilage grafts from
inside the nose itself, from the septum. When this is not possible,
for instance if the septum is twisted or damaged and needs rebuilding,
I’ll take the graft from behind the ear,” explains Dr Hodgkinson.
Bone grafts may also be necessary and these are usually taken from the
elbow.
Taking the grafts doesn’t require more than 15 minutes surgical
time and once harvested they can be crafted into the appropriate size
and shape. “This way they won’t show under the skin and
they will become an accepted and living part of the face,” says
Dr Hodgkinson.
continued column 2 >> |
 
BEFORE and AFTER Rhinoplasty performed
by Dr Hodgkinson
 
BEFORE and AFTER Rhinoplasty performed
by Dr Hodgkinson
 
BEFORE and AFTER Rhinoplasty performed
by Dr Hodgkinson
The area where the graft is taken is more tender and sensitive for
three to six weeks, not enough to be debilitating or to require time
off work, but Dr Hodgkinson recommends being careful with the healing
area for several weeks.
“For bone grafts we always take from the non- dominant arm,”
says Dr Hodgkinson. “The elbow has very loose skin so it heals
very well and the scar becomes imperceptible.”
Once in the nose the bone and cartilage grafts are well accepted.
“We’ve got X-ray follow-up after 20 years and the grafts
have become completely vascularised; it becomes a living part of the
face,” says Dr Hodgkinson.
The recovery for the rhinoplasty is the same as normal, where bruising
and swelling may occur in the first couple of weeks and the absolute
final result won’t be seen for up to a year. |
