Injectable Cartilage Shaving: An Autologous and Long Lasting Filler Material for Correction of Minor Contour Deformities in Rhinoplasty

Abstract

Background: Filler materials are gaining popularity in nonsurgical rhinoplasty the major advantages are the ability to camouflage the surface deformities, and also the soft and malleable consistency; while the major drawback of the safe fillers such as hyaluronic acid is short durability. In this study, we evaluated the injectable cartilage shaving as an autologous filler material for correction of minor contour deformities in rhinoplasty.

Methods: Injectable cartilage shaving was used for correction of surface irregularities in primary or secondary rhinoplasty, and long term results of 128 patients were evaluated. The source of cartilage was autologous septum, rib or less frequently, the ear concha. The material was injected with 14 to 18 gauge needles or blunted tip lipofilling cannulas with 1.3-1.7 mm internal diameters. It was performed whether during the septorhinoplasty or as a separate single procedure without elevation of the flap. Success was defined as the long term survival of the graft in the desired site and absence of recurrent deformity or complications such as extrusion, infection or displacement.

Results: Twenty seven males and 101 females underwent the procedure from May 2008 to January 2014. Mean follow up period was 31 (13-58) months. Ninety five percent of patients were satisfied or very satisfied with the results at the last follow up visits and touch up procedure was performed for the unsatisfied patients.

Conclusion: Injectable cartilage shaving is a reliable filler to correct and camouflage the surface irregularities, and it is durable and predictable in long term follow ups.

Keywords: Cartilage; Injectable; Rhinoplasty; Shaving.

Fig. 1

a: A 56 year old lady presented with severe asymmetry of the tip and alar cartilages, and aging face, b: facial rejuvenation and shaved cartilage injection to left side of nose, 3 years post operative feature

Fig. 2

a: A 45 year old lady presented with right side tip bossa formation, tip asymmetry and bilateral alar pinching were the most prominent complaints. b: Postoperative results after 30 months. She has had shaved cartilage injection to defective parts of nose

Fig. 3

a,d,g: A 48 year old lady with inverted V deformity, bilateral alar pinching and collapse of the internal valve leading to nasal airway obstruction. b,e,h: after secondary rhinoplasty using bilateral spreader graft, bilateral lateral crural strut graft, onlay tip graft (and chin augmentation). c,f,i: 18 months after injection of the cartilage shaving in supratip and radix

Fig. 4

a: Shaved cartilagenous tissue fragments with preserved lacunae, including chondrocytes, associated with normal architecture and usual staining of chondroid matrix. b: Crushed cartilage tissue fragments, with damaged lacunae, some of them devoid of chondrocytes, associated with damaged and degenerated cartilagenous matrix with some induced tearing