Beverly Hills Plastic and Cosmetic Surgery “Tip of the Day” from Beverly Hills Plastic and Cosmetic Surgeon, Dr. Francis R Palmer, III.

+�-�Rhinoplasty and Revison Rhinoplasty:

Sometimes during a Rhinoplasty or a Revision Rhinoplasty it may be necessary to use a graft to add support and/or shape to the nasal tip or nasal bridge.+�-� What are the choices and the best materials to use where?+�-� Are all materials the same?

No, all materials are definetly not the same.+�-� Some materials used as grafts tend to have many more complications and problems years after the Rhinoplasty or Revision Rhinoplasty.+�-� The following are my choices for graft materials with over 20 years experience performing Rhinoplasty and revision Rhinoplasty.

1. Nasal Tip:+�-� This area of the nose needs a soft material that will not absorb , dissolve or thin the overlying skin.

my choice: the curved section of the ear cartilage called conchal cartilage makes an excellent graft to the nasal tip…best of all it’s your own tissue.

my advice to avoid:+�-� L-shaped silicone implant where 100% erode through the skin within 15 years.+�-� Man made substances like Gortex and medpore that may become infected years later for no apparaent reason.

2. The nasal bridge:+�-� The graft should be strong, straight+�-�and not absorb.

+�-�My choice: Silicone dorsal grafts that come in different sizes and thickness…has a very real shape that’s similar to a normal aesthetic nasal bridge.+�-� No L-shapes, just the straight dorsal segments.

To avoid:+�-� Conchal ear cartilage tends to dissolve unevely when used on the nasal bridge.+�-� The same can be said about bone, rib cartilage and banked (irratiated cartilage).+�-� Uneven absorptiuon means deformity and this should be avoided as this will most likely result in a Revision Rhinoplasty to replace this graft with one that is more stable.+�-� Septal cartilage works well here but rarely can a piece be found that’s long enough to cover the entire distance of the nasal bridge.

+�-�Choosing the correct graft is a major part of proper pre op Rhinoplasty or revuision Rhinoplasty planning.+�-� The wrong graft or implant may mean a revsion Rhinoplasty in the future…so this is worth learning.

Dr. Francis R Palmer, III