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Apaydin. Plast Aesthet Res 2019;6:9 I http://dx.doi.org/10.20517/2347-9264.2018.73 Page 5 of 7

A B C

D E F

Figure 6. When thinner implants are used as lateral crural strut grafts, the patients do not palpate them from the inside (A); a similar
situation is valid for alar batten grafts as well (B); tip grafts can easily be carved from rib cartilage (C); paper thin implants can be used for
camouflage purposes (D, E); the remaining cartilages can be inserted into the recipient bed for support (F)

A B C

Figure 7. In younger patients, the thin implants are flexible enough to reconstruct the missing lower lateral cartilages partially or totally.
In this case, the lateral crura and the domes are reconstructed by thin rib implants (A, B); then a shield graft is sculpted for a better tip
definition and projection (C)

Revision rhinoplasty
The patients usually seek revision surgery due to over resection, under resection or persistent nasal
deviation. In cases of over resection, graft requirements can often exceed the amounts of cartilage that can
be harvested from conchal cartilages. In these situations, the oblique split technique has provided large
amounts of straight grafts of various thicknesses and lengths from a single rib, while avoiding technically
complicated and time consuming carving techniques. The volume and the variability grafts that can be
produced combined with the speed of the oblique split method affords the surgeon greater flexibility than
other methods. I have had a chance to cut paper thin implants to use as lateral crural strut grafts and
camouflage grafts [Figure 6]. In younger patients, the thinner implants can easily be bent to reconstruct the
lower lateral cartilages [Figure 7]. These thinner grafts avoid rigidity and stiffness associated with the use of
the thicker grafts.

In revision rhinoplasties and saddle noses, a very useful technique that I have used over the last 5 years is
to put paper-thin slices of cartilage, called as cartilage chips, within rectus abdominis fascia or temporalis
fascia. In my experience, this is a superior technique than diced cartilage in fascia (a technique which I have
used for 8 years), because although very similar in purpose, it stays much firmer on the dorsum than diced
cartilage, so the patient is not able to make any changes with the shape of the dorsum [Figure 8].