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The ultimate nose-sculpturing surgery – Costal cartilage rhinoplasty


The nose can stand tall on the face because it has the "support" from the nasal bone and nasal cartilage, and the strength of such support determines the shape of the nose. Therefore, the nasal bone and nasal cartilage are like the building's reinforced concrete, playing a supporting role in the nose sculpturing surgery.
In nose-sculpturing surgery, the materials that play the "supporting" role must be autologous tissues rather than the artificial ones. It is because such supporter must withstand pressure for extensive period of time, and the artificial materials will eventually displace or protrude under the skin surface. The best autologous tissues, meanwhile, are the autologous cartilage because its hardness can provide enough support and yet not hard to the extent to cause issue, so it is the best material.
The costal cartilage is located between the ribs and the sternum (see figure) and can provide a large amount of materials, so it is an important source of cartilage material for nasal reconstruction. Costal cartilages are less used in the nasal plastic surgeries, but in some severe cases of collapses, costal cartilages are still required.
The method is to incise an opening of 3-4cm in the lower edge of the sternal and then take out the costal cartilages, and then carve out the shape according to the area that needs the support to extend the nasal septum and pad the nasal tip and nasal bridge.
Rhinoplasty with Autologous Tissue
Most Oriental has the demand of increasing nose bridge, but some of them prefer it shorter or smaller. Therefore, I would name Rhinoplasty for Oriental ‘Nasal Sculpture’.
As a result, Nasal Sculpture requires artificial implant so as to higher nose bridge and nasion, even lengthen nasal septum.

Artificial implant used in Nasal Sculpture:

Advantages of artificial implant:
1.Since it is unable to be absorb by human body, the size will be constant without changing.
2. Exist forever.

However, there are still some problems when artificial implant is applied in Nasal Sculpture:

1. ‘Might’be unnatural.
2. Low probability of having capsular  contracture.
3. When affected by bacteria, the removal of implant is necessary.
Severely or mildly, human body will have unpredictable response when non-autologous object is placed inside. At clinical cases, as human body has severe reaction toward artificial implant, it brings out the shape of the implants, then the nose seems to be fake. Even worse, not only nose distortion or shortening, leaking implants will also occurs due to capsular  contracture.
Autologous Nasal Sculpture, using autologous rib cartilage as implant, had been proposed in early years. However, there are several downturns applying rib cartilage to higher the nose bridge. First of all, the displacement and bending happen easily. Secondly, it is not possible to shape the nasion. With these imperfections, Autologous Nasal Sculpture still leaves much to be desired.
We never stop to advance Autologous Nasal Sculpture. In recent years, we have introduced autologous dermis, fascia and grilled cartilage as implant, bringing countless successful and satisfying outcomes. All in all, with our strong desire of perfection, there is no doubt that Autologous Nasal Sculpture can totally be expected. 
Autologous implants used in Nasal Sculpture:
1. Ear Cartilage
2. Septal Cartilage
3. Dermal Fat
4. Rib Cartilage
5. Fascia
6. Diced Cartilage

Nasal Sculpture using Rib Cartilage

Compare to three years ago, to me, there is a brand new level of experience of Autologous Nasal Sculpture. The risen of Autologous Nasal Sculpture was to overcome complications caused by artificial implant. The early Autologous Nasal Sculpture was specifically referred to Autologous Costal Cartilage Nasal Sculpture. By using autologous rib Cartilage, this firm material causes no rejection and has sufficient supply for the surgery.
However, it takes more time and seems unnatural when Autologous Rib Cartilage is used to higher the nasal bridge; furthermore, using this implant is unable to build up the curve combining eyebrows and nose. Autologous dermis and fascia then become another choice for surgeon: it is simple to acquire and apply. The only downside is that its absorption is unstable, which indicates that the outcome of surgery is uncontrollable.
At present, we use autologous dermis and fascia in the following criteria: capsular contracture caused by times of surgeries, displacement or infection of artificial implant and the case that patient refuses to use artificial implant. The development of Autologous Nasal Sculpture aims to overcome the complication caused by hard rib cartilage and improve the unstable result of using autologous dermis and fascia.
We advanced the nasal sculpture surgery by using grilled rib or ear cartilage. Even this technic is not newly invented, but it successfully improves the old method, bringing solution to uneven nose bridge.
The joy of life is that everything is possible. Even surprised by the new technology, it could never be long. For plastic surgery, it might not be a bad thing. There’s a saying that I strongly agree with and always put in practice,’ Advancing my skill to benefit patients is my lifetime goal. Only by devoting myself into learning and making every effort to improve myself, I am able to do the surgery even better.’




Dr. Yi-Sheng Kao Director | Plastic Surgery Aesthetic Clinic

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