See how Rhinoplasty Surgeons carve a Dorsal Augmentation graft using septal and ear cartilage.
Dr. Lamperti, narrates an intra-operative video showing how he makes a three-layered, laminated Asian rhinoplasty dorsal augmentation graft out of a patient's septal and ear cartilage. He shows how the cartilage is carved, how the individual layers are sutured together, and how the graft is trimmed to prevent unwanted sharp edges.
"This is Seattle facial plastic surgeon, Dr. Thomas Lamperti. Today I'm going to show you how to make an Asian rhinoplasty dorsal augmentation graft using cartilage. In this specific case we're going to be using a mix of both septal cartilage and ear cartilage from a patient. Here I am measuring the length of each cartilage graft. This is based off of the length of the bridge of the patient that needs to be augmented. Here I am trimming the harvested ear cartilage from the patient that I had harvested earlier in the case. One of the benefits of using a patient's own cartilage is that the graft can be fully customized based off of the actual width that is needed and also the length. There is also the benefit, of course, of using your own tissue. There is a much lower risk of rejection or infection down the road.
Now that I have two layers of cartilage based off of the septum and ear cartilage I'll now layer or laminate them. They are actually connected using sutures. In this case I'll be using a mixture of both dissolvable, or resorbable, sutures and also permanent sutures. This is mainly in areas that I want to ensure that cartilage does not want to buckle, especially given the natural shape of the cartilage in that area. With time each layer of cartilage will actually scar to each other. This is typically done after several months. The sutures are mainly to ensure that there aren't any changes during the healing process. The actual thickness of the graft is also dependent on the needs of the patient and their desires. Some patients only need one layer of cartilage if they only need minimal augmentation whereas other patients may need more than one, up to two or three. This patient will actually have a three layer graft ultimately using one layer of septal cartilage and two layers using the ear cartilage.
You may have noticed that there is actually additional septal cartilage that we could have used. You may be wondering why I'm not using it for the bridge. The main reason is that I'm actually performing other maneuvers during this rhinoplasty on the tip of the nose in which I require the strong, straight cartilage of the septum. Ear cartilage isn't typically as strong as septal cartilage and has a natural curvature of the conchal bowl. This can be used on the dorsum regardless. You can now see the graft coming together, looking nice and straight. Once we're done suturing the layers together we'll then be able to bevel and trim the edges so that there are no sharp edges. This is what we're doing now with our scalpel. As you can imagine the top of the bridge typically has a gentle curve rather than a sharp edge. We want to make sure this is continued with the graft. Now that we have made the graft and it is fully in place we'll now insert it in the bridge pocket to make sure that it gives us the precise level of augmentation that we desire."