Auricular Cartilage in Revision Rhinoplasty

Figure 9 (A) This patient had nasal surgery after a nasal fracture as a young adult. He complained of nasal breathing and has severely pinched narrow nasal valves and nasal valve collapse. (B) Large alar batten grafts were placed, improving the strength and appearance of his nasal sidewalls.

Figure 10 (A,B)This patient had an alloplastic implant placed, which became infected.The infected implant caused a cutaneous fistula and destruction of nasal tip soft tissue.

We have found that the portion of cartilage along the antihelical rim is especially suitable for dorsal grafting due to the relatively flat shape of this cartilage. Grafts may be laminated or layered to increase the size of the dorsal augmentation when needed. In this patient exam­ple, a double-layered cartilaginous onlay graft was used (Fig. 8). This was wrapped in Alloderm due to the pa­tient's thin skin. When onlay grafting is placed beneath the soft tissue envelope, great care must be taken so that the edges of the graft are smooth and also that the graft is not too wide; otherwise, the edges may be palpable or visible.

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