Rhinoplasty may require the addition of material to augment the nose. Augmentation is necessary for both aesthetic and functional indications. Functional reasons for augmentation include providing structural support for areas deficient of material, such as the upper or lower lateral cartilages. Augmentation may also be required for aesthetic reasons. Typically, augmentation rhinoplasty is performed to increase the projection of the nasal dorsum on the profile view. The nasal tip may also be augmented.
The patient must have a clear understanding of the realistic goals of the operation. He or she must be informed of the potential risks, as well as the pros and cons of taking the graft material from the available donor sites. The patient must have the opportunity to make an informed decision about the planned procedure and about the type of graft material is to be used. The patient must also understand the importance of accepting compromises. For example, meeting the preconsultation aesthetic ideals of the patient and still achieving a functionally competent nose may not be possible.
Table. Advantages and Disadvantages of Graft Materials (Open Table in a new window)
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|
Advantages |
Disadvantages |
| Septum | Easy harvest
Present in the surgical field (no separate donor-site morbidity) Straight (good for certain purposes, such as a columellar strut) |
May be deficient
Straight (less desirable as batten graft) |
| Auricle | Easy harvest
Relatively abundant Curved nature ideal for certain purposes |
Separate donor site
Curved (less desirable for some purposes) |
| Rib | Large volume (abundant, even for significant augmentation)
Distant donor site (2-team approach possible) Reliable |
Donor-site morbidity
Warping possible |