As my rhinoplasty practice has exploded over the last 8 years I have seen more and more revision rhinoplasty patients than ever before. As a result I am seeing more people who have had their bridges over reduced which results in a very sloped and unnatural look. To correct this problem we “augment the dorsum” which is a fancy way of saying we build the bridge back up. There are several ways that I do this.
For people who need only minimal augmentation I prefer to use their own cartilage from their septum. Septal cartilage is very easy to work with and provides the perfect thickness and strength to place on the bridge or the tip. For people who require more substantial augmentation I prefer one of 2 techniques. I use either a specialized implant or a sandwich made up of diced cartilage and temporalis fascia. The latter option is basically dicing up the persons own cartilage into tiny pieces and placing it inside tissue that is taken from the forehead. This sandwich is very soft and gives an excellent augmentation and is ideal for people with thin skin. When a person has thin skin it is easy to see through the skin and therefore using a person’s own tissue is appropriate because it helps to camouflage the augmentation whereas an implant can sometimes show through the thin skin. For people with medium or thicker skin I prefer to use a specialized implant which is made of silicone wrapped in a very thin fine layer of e-PTFE which is a specialized type of super soft gortex. This implant is the perfect consistency for the bridge and gives a perfectly smooth bridge, smoother then any other method can offer. For those people who require full tip reconstruction as well as bridge reconstruction I often will use that persons own rib to rebuild the entire nose. Rib cartilage provides an excellent source of cartilage when a large amount of cartilage is required.
I have a lot of experience with all of the above methods and I use more of the specialized implants then any other method. The implant eliminates the need to harvest tissue form another site and therefore makes the surgery more minimal and requires less healing. The other listed methods are excellent options as well and the appropriate method has to be tailored to the appropriate patient to get long lasting and outstanding results.