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wasperformed FacialSurgery.com
Steven M. Denenberg, M.D.
Steven M. Denenberg, M.D.

FAQ:

Building up the nasal bridge

We occasionally want to build up, or augment, the bridge of the nose during a rhinoplasty.  (The "bridge" is what I call the profile line of the nose, the part that you trace with your finger if you put your finger on your nose between your eyes and slide it down to your tip.  Plastic surgeons call that part of your nose the "dorsum.")

Perhaps the bridge has caved in after an accident, or maybe it was lowered too much during a previous rhinoplasty.  Some people are born with a bridge that naturally sits close to the face.  For example, most Asian noses have low nasal bridges, and Asian rhinoplasty patients frequently request that the bridge of the nose be strengthened.

Here is an example of a nasal bridge that was augmented during a rhinoplasty:

Many different materials are used to elevate the bridge of the nose.  The main decision that the surgeon makes is whether to use natural materials taken from the patient or from another person, or whether to use one of the artificial materials that are safe to place in the nose.  Each category has its advantages and disadvantages.

The most common natural material is cartilage, which can be taken from the nasal septum, or from the ear, or from a rib.  The location from which the cartilage is taken depends mostly on how much cartilage is needed.  If a very large graft is required, rib will be used.  The nasal septum or the ear can serve as a source of cartilage for smaller grafts.

Many surgeons prefer to use artificial materials to build up the bridge of the nose.  Dr. Denenberg prefers Gore-Tex®, which has many advantages over cartilage.  Cartilage is firm, like the cartilage that covers the end of a chicken bone, and the cartilage that can be retrieved from the septum or the ear is exceedingly difficult to carve so that it is the right size and shape, and so that it won't show any sharp edges or ridges or corners underneath the thin skin of the nose.  Gore-Tex® is like a thick piece of cloth, that can be draped over the area of the bridge of the nose.  It doesn't show any edges or corners underneath the skin, and it looks very natural.  It also doesn't require the additional surgery that is necessary to obtain a cartilage graft, and it is available even if all of the other nasal and ear cartilage has already been harvested during a previous operation.

Other natural and artificial materials are available as well.  A thin piece of bone can be taken from the skull to place along the bridge of the nose.  Solid silicone is an artificial material that can work well in some people.

Plastic surgeons argue continually over which material is the best.  Different doctors have different favorites.  In general, if you need augmentation of the bridge of your nose, don't go about it by deciding which material you would prefer and then finding a plastic surgeon who uses that material.  Plastic surgeons who can do this operation competently are too rare.  If you find a plastic surgeon who appears to be excellent, and he shows you photographs of other patients who had their noses augmented with excellent results, then certainly discuss your thoughts with him, but allow him to guide the final decision.  He knows what materials work best in his hands.

Go here for more information on finding a plastic surgeon who is competent to perform a rhinoplasty.


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