In rhinoplasty, grafts are used very commonly. A graft is a piece of your own tissue moved from one part of the body to another. Cartilage, bone, fat, fascia, and perichondrium can all be used in the nose during rhinoplasty.
Soft-Tissue Grafts
Soft-tissue grafts include fat, fascia, and perichondrium. Occasionally fat is harvested and used as graft material; this is uncommon and usually reserved for revision cases where the skin and soft tissue have extensive damage and scarring from prior operations. Fascia and perichondrium are used more routinely, even in primary rhinoplasty. Fascia can be harvested from the temple or the abdomen, while perichondrium (the soft tissue that surrounds cartilage and supplies its blood) is typically harvested along with rib cartilage.
These soft-tissue grafts are sutured to the nasal cartilages to camouflage some areas and add definition to others. They are particularly helpful in patients with thin skin, where the smallest imperfection in the underlying framework can become visible during healing; the graft helps soften and conceal those edges.
Cartilage Grafts
Cartilage is the tissue that gives structure to your ear and most of your nose: strong, yet flexible. In rhinoplasty, cartilage can be taken from the nasal septum, the ear, or the rib.
The nasal septum is the most commonly used and most favorable source. It sits in the same surgical field, is often removed anyway to correct deviations, and has ideal mechanical qualities: strong, thin, and straight.
Ear cartilage can also be used. Because it is softer and curved, it is less ideal in most situations, but it is a good option when only a small amount of cartilage is needed, or when cartilage with overlying skin is required. The shape of the ear does not change after the graft is taken, and patients typically report about a week of discomfort.
Rib Cartilage Grafting
In most revision rhinoplasty cases, a rib graft is necessary: the native septum has usually already been used or removed, and ear cartilage is often insufficient in quantity or quality.
Humans have 12 pairs of ribs. Dr. Namin typically harvests a 3-4 cm segment of cartilage from the right 6th or 7th rib, through a 3-4 cm incision beneath the right breast or pectoral muscle. These ribs usually sit below the lining of the lungs; even so, there is always a small risk of pneumothorax (a collapsed lung) when harvesting rib cartilage. If this were to occur, steps are taken to re-expand the lung, and a small chest tube is rarely required.
Once harvested, the incision is closed and the rib is carved into long, thin grafts roughly 1 mm thick. This provides an ample supply of strong, thin cartilage to reconstruct the nose. The grafts are then soaked in saline while the nasal surgery begins; this lets Dr. Namin watch for any warping or curving of the cartilage, which can usually be seen during the soak.
Anticipated Recovery
After surgery you will have surgical glue over the rib incision. Pain is mild to moderate and usually worst during the first few days; by about post-operative day 7, very few patients have any pain. You may let water run over the incision in the shower beginning the day after surgery, but do not submerge it underwater until four weeks after surgery.
Anticipated Recovery Timeline
Day of Surgery. You will wake up with surgical glue over the rib incision.
Post-Operative Days 1-3. Pain is typically at its worst during this window. Dr. Namin will prescribe pain medication. You may shower and allow water to run over the incision.
Post-Operative Day 8. Dr. Namin will see you back in clinic. The surgical glue will begin to fall off.
Post-Operative Week 4. Dr. Namin will see you for your second post-operative visit. You may resume vigorous exercise and submerge the incisions underwater.