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

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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.

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Conflict of interest

The authors have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Plastic Surgery Department, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey

    Ahmet Demir

  2. Plastic Surgery Department, Faculty of Medicine, Gazi University, Ankara, Turkey

    Selahattin Özmen

  3. Plastic Surgery Department, Faculty of Medicine, Ufuk University, Ankara, Turkey

    Basar Kaya

  4. Plastic Surgery Department, Erzurum Regional Research and Training Hospital, Erzurum, Turkey

    Betül Ak

  5. Plastic Reconstructive and Aesthetic Surgery Department, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey

    İsmail Küçüker

Authors
  1. İsmail Küçüker
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  2. Selahattin Özmen
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  3. Basar Kaya
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  4. Betül Ak
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  5. Ahmet Demir
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Correspondence to İsmail Küçüker.

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Küçüker, İ., Özmen, S., Kaya, B. et al. Are Grafts Necessary in Rhinoplasty? Cartilage Flaps with Cartilage-Saving Rhinoplasty Concept. Aesth Plast Surg 38, 275–281 (2014). https://doi.org/10.1007/s00266-013-0258-2

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  • DOI: https://doi.org/10.1007/s00266-013-0258-2

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