Revision Rhinoplasty Using Glued Diced Costal Cartilage Shaped With Mold for Management of Complicated Silicone Rhinoplasty

Overview

A silicone implant that has caused problems must be replaced with something, and choosing that replacement material is the hard part. The authors report their experience with a molded glued diced cartilage graft, in which rib cartilage is chopped fine, bound with glue and shaped in a mold. They retrospectively reviewed records from a tertiary center between 1 February 2018 and 28 February 2022.

Sections of note

• Design: retrospective medical record review, 28 patients, 9 men and 19 women, single tertiary center.
• The principal reason for revision was cosmetic dissatisfaction. Mean follow up was 18.3 months.
• All patients had dorsal augmentation with molded glued diced cartilage. Other techniques included caudal septal extension, extended spreader grafts and tip grafts.
• 91.1 percent were judged good or excellent on aesthetic outcome scoring.
• Significant increases in dorsal height 2.78 percent, radix height 2.26 percent, nasal length 7.53 percent, tip projection 2.40 percent, and axis deviation reduced 1.15 degrees, all p less than 0.05.
• Two patients had complications: one infection and one case of cosmetic dissatisfaction.

What it means for a patient

• Replacing a problem silicone implant with your own rib cartilage, chopped and molded, gave good or excellent appearance in nine of ten patients here.
• Using rib means a chest incision and a second surgical site, which the abstract does not discuss.
• The measured shape gains were small in percentage terms, in the range of 2 to 8 percent.
• Limits: 28 patients, one center, retrospective, no comparison group, follow up under two years, and aesthetic outcome scored without a named validated tool.

Why this paper matters

Silicone augmentation is common in Asian practice and its failures generate a steady stream of revision cases in which the bridge must be rebuilt from scratch. Molded diced cartilage offers a shapeable, entirely autologous option. Long term resorption and comparison with solid rib grafts remain open.

Terms

• Diced cartilage: cartilage cut into tiny pieces so it can be molded like a paste.
• Costal cartilage: cartilage from the ribs, harvested for use as a graft.
• Dorsal augmentation: adding height to the bridge of the nose.
• Radix: the root of the nose, the area between the eyes.
• Caudal septal extension: a graft fixed to the lower septum to set tip position.