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Aesthetic Plastic Surgery

, Volume 38, Issue 2, pp 275–281 | Cite as

Are Grafts Necessary in Rhinoplasty? Cartilage Flaps with Cartilage-Saving Rhinoplasty Concept

  • İsmail KüçükerEmail author
  • Selahattin Özmen
  • Basar Kaya
  • Betül Ak
  • Ahmet Demir
Original Article Aesthetic

Abstract

Background

Cartilage grafts are used routinely in rhinoplasty, but are they necessary? Can we support the normal anatomy by preserving and transposing the adjacent tissues? In this study we hypothesize that during rhinoplasty, cartilage flaps can give adequate support and may decrease the need for cartilage grafts.

Methods

Included in this study were 147 patients who underwent an open rhinoplasty technique under general anesthesia between January 2010 and May 2012. Mean operative time was 73 min (range = 44–120 min). After dissection and septoplasty (if needed), we performed dorsal bone and septal reductions. Following reduction, upper lateral cartilage superior segments were preserved and turned inward as cartilage flaps to replace the spreader grafts. Lower lateral cartilage cranial parts were not excised and were slid over the caudal part to replace the alar strut grafts. Cartilage from the caudal nasal septum was not excised; instead, lower lateral cartilages were cephaloposteriorly displaced with a tongue-in-groove technique to support the nasal tip.

Results

Mean follow-up time was 19.6 months (6–30 months). All patients but 12 were satisfied or completely satisfied with the results. Among the 12 unsatisfied patients, four complained of a one-sided inverted-V deformity (secondary spreader grafts were added), three had supratip deformity (secondary additional dorsal septal excisions), two demanded extra tip definition (secondary tipoplasty), two were unhappy with the bone symmetry (secondary osteotomies), and one complained of hanging columella (secondary excision from the caudal septum).

Conclusions

Cartilage flaps have some advantages over cartilage grafts. First, graft harvest is not needed in the former; second, because flaps are a part of the normal anatomy, they provide a good tissue match, making fixation easier. However, the tongue-in-groove technique cannot be used in patients who do not need caudal excision, and cartilage flaps can be inadequate in some patients who may need additional grafts.

EBM Level IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Keywords

Rhinoplasty Graft FLAP Spreader flap Septoplasty Cartilage flap Strut graft Tongue in groove 

Notes

Conflict of interest

The authors have no conflicts of interest to disclose.

Supplementary material

Supplementary material 1 (MP4 49429 kb)

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Copyright information

© Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2013

Authors and Affiliations

  • İsmail Küçüker
    • 5
    Email author
  • Selahattin Özmen
    • 2
  • Basar Kaya
    • 3
  • Betül Ak
    • 4
  • Ahmet Demir
    • 1
  1. 1.Plastic Surgery Department, Faculty of MedicineOndokuz Mayıs UniversitySamsunTurkey
  2. 2.Plastic Surgery Department, Faculty of MedicineGazi UniversityAnkaraTurkey
  3. 3.Plastic Surgery Department, Faculty of MedicineUfuk UniversityAnkaraTurkey
  4. 4.Plastic Surgery DepartmentErzurum Regional Research and Training HospitalErzurumTurkey
  5. 5.Plastic Reconstructive and Aesthetic Surgery Department, Faculty of MedicineOndokuz Mayis UniversitySamsunTurkey

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