Cartilage Chips in Rhinoplasty

Overview

The study set out to show that cartilage chips can serve for camouflage and for building up areas of the nose. Sixty four patients operated on between 2014 and 2019 were reviewed retrospectively, with an average age of 31. Forty nine had first time rhinoplasty and 15 were revision cases. Chips were cut to under 0.5 mm thick with dimensions ranging from 2 to 10 mm.

Sections of note

• Retrospective study of 64 patients, 49 primary and 15 revision.
• Chips were used to fill a deep radix, depressions at the keystone area, the supratip area, and around grafts to prevent them showing at the tip.
• They were also placed inside fascia for building up the bridge.
• Chips were carved from septal cartilage in 47 cases, rib in 16 and ear cartilage in 1.
• Application sites were the radix in 25 cases, the middle vault in 37, the supratip in 32 and the tip in 12.
• In 30 cases chips were mixed with cartilage dust for better fixation and camouflage.
• They were placed in fascia in three cases for bridge augmentation.
• Complications occurred in three cases, all in the form of irregularities.

What it means for a patient

• Chips are thin flat pieces rather than diced fragments, used to soften edges and fill small hollows.
• Most were carved from cartilage already being harvested from the septum, so no extra donor site was needed in the majority.
• Three of 64 patients developed visible or palpable irregularities, which is the specific problem the technique aims to prevent.
• This is a retrospective series with no comparison group, no stated follow up length and no satisfaction measure.

Why this paper matters

Camouflaging edges and filling small depressions is the finishing stage of rhinoplasty and is where thin skinned noses most often fail visibly. This series documents one material used across four regions of the nose. It offers no comparison with diced cartilage or fascia alone.

Terms

• Cartilage chip: a thin flat piece of cartilage used for camouflage or filling.
• Cartilage dust: finely crushed cartilage, here mixed with chips to hold them together.
• Radix: the root of the nose between the eyes.
• Keystone area: where the nasal bones meet the cartilage of the bridge.
• Supratip: the area of the bridge just above the tip.
• Camouflage: concealing edges and irregularities with a soft covering layer.