When performing reconstructive or cosmetic surgery procedures on the face, it is often necessary to add material that can be sculpted and contoured to accentuate specific facial features or create new ones. Both otoplasty (ear surgery) and rhinoplasty (nose surgery) may require the use of additional flexible material to sculpt new structures, and facial contouring frequently makes use of implants to add definition to the cheekbones or chin. For all of these procedures, I prefer to use cartilage from the patient’s own body rather than artificial implants whenever possible so as to avoid allergic reaction, surgical rejection, and the risk of post-operative infection.
Cartilage is a strong and flexible supportive and connective tissue made up of a gelatinous ground substance called chondroitin sulfate mixed with collagen and elastic protein fibers. Together, these components form a matrix that is flexible, yet highly durable and resistant to compression forces. The most abundant type of cartilage, hyaline, is found as supportive tissues in the nose, ears, trachea, larynx, and smaller respiratory tubes. Hyaline cartilage also reduces friction and acts as shock-absorbing tissue between the bones in most joints and forms the attachment of the ribs to the sternum, allowing the entire rib cage to expand and contract during respiration.
Cartilage is preferable to artificial implants for a number of reasons. Implants made from artificial materials can be excessively rigid, creating results that appear unnatural. Implants used to supplement or replace the structural framework of the nose during rhinoplasty can also, over time, exert pressure on the skin, ultimately causing it to thin to the point where the implant becomes visible. Cartilage, however, is highly moldable and can blend seamlessly with the patient’s own tissue, healing with the body and providing results that appear most natural. Cartilage will also warp when scored with a sharp implement, making it ideal for sculpting the curves and arches that appear in the outer ear when necessary in reconstructive otoplasty. Finally, because the cartilage is the patient’s own tissue, there is a significantly reduced risk of infection, bone erosion, or rejection.
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