Summary :
External Transcolumellar Approach
Other surgical approaches
Deviated noses
Augmentation rhinoplasty
Functional graft
Graft of the nasal tip
Secondary rhinoplasties

Chap V - Augentation Rhinoplasty of the Dorsum and Radix


Cartilage grafts are frequently used in rhinoplasty . This cartilage is most often taken from the septum or from behind the ear . The objectives of cartilage grafts are to prevent a weakening of the skeletal structures once a reduction rhinoplasty has been performed , to improve the harmony of the nose by bringing an equilibrium between the differents areas of the nose and also to impprove the shape of the nose or to augment the nose.

Cartilage grafts can be placed in the root , the dorsum, the middle vault , the tip , the ala ,and the columella.

Radix grafts to the radix are indicated when there is a depressed radix and large nasal base which would otherwise require a very extensive or even impossible reduction and also when there is a large nasal hump which looks less prominent after augmentation of the radix and consequently will require less reduction.


Fig. 1 Cartilage grafts on the dorsum

The goal of a dorsal graft is to provide normal height as well as harmonious continuity with the radix by two curved and slightly divergent lines , extending from the supra-ciliar ridges to the tip defining points and which are always separated by at least 5 mm . The width of radix and tip defining points should therefore be a guide for the determination of the width of dorsal grafts

Septal cartilage is the material of choice for the nasal bridge because of its consistency , its flat shape and the ability to be incised or crushed and used as multilayered grafts.


Fig. 1

Fig. 2
Fig. 2 Sculpting the grafts

To tailor the graft, the surgeon must consider the convex contour of the bony cartilaginous dorsum and the variable thickness of the overlying soft tissues . the ends of the grafts can be feathered by crushing and the edges bevelled with a blade

Crushing the graft allows a modelling of the graft which will adapt to the underlying structures



Fig. 3 Augmentation of the dorsum with a two layered cartilage graft and modeling of the nasal tip

A two layered septal grafts are assembled by sutures

The doctors AIACH and DURON are known for plastic surgery of the nose