A case study on the depressed nose by Dr. Ashok Tandon, Cosmetic Surgeon in Delhi.
This young boy presented with a depressed nose after an injury. A transverse injury mark at the base of the nose was a persistent reminder of the problem.
Correction involved using a shaped piece of Rib cartilage to build up the nose. The results were fair.
Such massive deficiencies do not lend themselves to correction with septal cartilage or conchal (ear) cartilage as a thick, long and stiff graft is needed. Such generous amounts are only available in a coastal area. The scar is only a finger long, about 6-7cm and there is no deformity of the chest wall.
Synthetic substitutes have fallen out of favor with most surgeons because of a high rate of long-term complications. Once a sinus develops, the implant must come out for the sinus to heal. Medpore is a popular synthetic material and generally well tolerated, but its removal is hell because tissue grows into its porous structure and fixes it. Silicone does not get fixed but stays mobile. Side to side movement is not liked by the patient as Isis uncanny and unnatural.
Cartilage grafts do not have these defects but can warp- twist with time. Bone grafts don’t warp but can lose volume. Cartilage grafts don’t lose volume, unlike bone grafts.