Motivation for this blog: To have a major resource center that will better inform those considering revision rhinoplasty in order to make well informed decisions; based on my own personal experiences as a nose revision patient, as well as my research.
Tragal cartilage graft is taken from the tragus region of the ear. Gubiesch and Kotzur in a three year study reported in 2003, using tragal cartilage grafts in 84 cases none experienced donor site morbidity. They were able to harvest grafts up to 1.5cm by 1.5 cm in size. The advantage of tragal cartilage over conchal cartilage is that it is flat and less elastic. The authors consider it, therefore, to be the ideal graft for augmentation of the dorsum, compensation of irregularities, or correction of open roof deformities. They also claim that the tragus is easily accessible, as a donor site. In another 2007 study Cochran and Defatta determined that the tragus provides a simple, convenient alternative source of cartilage for rhinoplasty in graft-depleted patients. Tragal cartilage grafts were used in three primary and three secondary
rhinoplasty patients. Postoperative follow-up ranged from six months to
12 months. Tragal cartilage was used as five alar contour grafts, one
lateral crural onlay graft, one dorsal onlay graft, and one infratip
lobule graft. Tragal cartilage was used to close the septal perforation
of one patient. Tragal contour was preserved in all patients, and there
were no complications noted with this procedure.
One study did find a negative side effect to use of tragal cartilage removal. Pothier D.D & Charaklias N. in 2006 study showed ten of the 12 patients in the tragal harvesting group who had used "
in the ear"earphones pre- and post-operatively had had problems with earphones
post-operatively, which in eight cases were due to pain or the devices
falling out. Of the 12 respondents in the non-tragus group, only one had
similar problems (p<0.05).
Rhinoplasty surgeons are striving to respect ethnic nasal variations realizing that patients typically want to refine their nasal appearance yet preserve their ethnic features. This respect serves to maintain facial harmony among the esthetic units and tends to achieve a natural look.
Dr. Ferdinand A. Ofodile Plastic Surgeon cert. 1976
Dr. Jennifer Parker Porter E.N.T/Facial Plastics cert. 1998
Dr. Sam Rizk E.N.T/Facial Plastics cert. 2000
Dr. Oleh Slupchynski E.N.T/Facial Plastics cert. 1998
Dr. Jeffrey Epstein E.N.T/Facial Plastics cert. 1994
Dr. David Kim E.N.T/Facial Plastics cert. 2003
Dr. Sam Nacify E.N.T./Facial Plastics cert. 1999
Dr. Samuel Lam E.N.T./ Facial Plastics cert. 2002
Dr. Derek Kofi O Boahene E.N.T/Facial Plastics cert. 2005
Dr. Babak Azizzadeh E.N.T/Facial Plastics cert.2003
Dr. Monte Harris E.N.T/Facial Plastics cert.2000
Dr. Philip Young E.N.T/Facial Plastics cert.2005
Dr. Paul Nassif E.N.T/Facial Plastics cert. 1998
Ethnic features: one nose does not fit all Dr. David W. Kim
Anatomical Variations
Disclaimer: it is overly simplistic to classify a non-Caucasian nose as
an “ethnic” nose to which “ethnic rhinoplasty” principles apply. Two
noses from two different ethnic backgrounds are likely to be as
different from each other as they are from a Caucasian nose. In
addition, significant variations in facial features are found within any
given ethnic group. That being said, three broad nasal morphology types
have been used to describe ethnic variations. The leptorrhine (“tall
and thin”) nose is associated with Caucasian or Indo-European descent.
Because it is the most extensively studied in modern nasal analysis, it
also inevitably becomes the reference point for comparison when studying
noses of different ethnicity's. Only recently have non-Caucasian
standards of nasal analysis been developed for specific ethnic groups.
The platyrrhine (“broad and flat”) nose is associated with African
descent. It is characterized by thick skin, a low radix, a short dorsum,
a bulbous and underprojected tip, and flared nostrils. An analysis of
the African-American female nose shows that compared to the Caucasian
standard for nasal analysis, the columella-to-lobule ratio is decreased,
and the alar width relative to the intercanthal distance is increased. The mesorrhine (“intermediate”) nose has features intermediate between
the leptorrhine nose and the platyrrhine nose. The “typical” Asian or
Latino nose is commonly regarded as mesorrhine, with a low radix,
variable anterior dorsal projection, rounded and underprojected tip, and
rounded nostrils. In Dr. Kim’s practice, patients of different backgrounds tend not to
want to strive for measurements and metrics consistent with a Caucasian
leptorrhine nose. Rather, many patients prefer to soften certain
features of their nose while retaining some of their “ethnic identity”.
