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Injectable Cartilage and Fat in Rhinoplasty

 

The concept of injectable treatments has expanded to a wide variety of aesthetic facial uses over the past decade. From a single site enlargement like the lips to more extensive facial rejuvenation, injections offer an easy way to quickly add volume. Even the nose, once a basion of being changed exclusively by surgical manipulation, also can now have some changes without open surgery.

Known as an injectable or non-surgical rhinoplasty, using synthetic hyaluronic fillers (e.g.,  Restylane, Juvederm) to build up the dorsum or fix asymmetries caused by concavities in any part of the nose  is now well known. But synthetic fillers are not the only possibility for nasal injection. Fat and cartilage injections are now entering the mix as injectable materials.

At the annual 2012 American Society of Plastic Surgeons meeting in New Orleans, several papers were presented on nonsurgical methods for rhinoplasty. One of the papers described one surgeon’s experience injecting diced cartilage into prepared pockets different areas of the nose including the dorsum, columella and the tip in over 600 patients. The key here is that these are prepared pockets, meaning placed during a surgical rhinoplasty procedure. In following some of the patients out to five years, only 29 patients experienced partial resorption which was treated by a second injection.

This presentation out of Turkey is an extension of a published paper in the July 2012 issue of Plastic and Reconstructive Surgery. In over 3800 rhinoplasties, the author discusses the value of reshaping the nasal tip using diced cartilage in a prepared pocket. Besides good aesthetic results, diced cartilage offered the advantage of no late show that is well known to occur with other type of cartilage graft preparations.

The other paper looked at a relatively new use of fat grafting into the nose in nearly 60 patients, either done by injection or as part of an open rhinoplasty. Fat grafting was done alone in only 12 of the patients while the remaining47 patients had fat grafting combined with other rhinoplasty maneuvers. While many of the patients had visible improvement, the study of the outcomes was only carried out for eight weeks after the procedure.

The use of diced cartilage and fat injections in rhinoplasty has a useful role which is yet to be precisely defined. Diced cartilage has had more extensive use and, for now, is more predictable when injected than fat. But the one big difference in autologous tissue injections than synthetic fillers in the nose is that they are still a surgical procedure, even if it is a relatively small one. Pockets must be created to receive the grafts. These are chunks of tissue being introduced rather than a smooth flowing material than can be placed through a tiny 30 gauge needle. In addition, there must be a harvest and the graft material does not come off-the-shelf. Thus they are not an office procedure and are not really a non-surgical rhinoplasty. Diced cartilage and fat is an adjunctive grafting method for surgical rhinoplasty.

Dr. Barry Eppley

Indianapolis, Indiana

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Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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