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FIGURE 18. Use of multiple facial grafts. (A)Preoperative view of patient with depressed nasal tip, acute nasolabial angle, receding chin, bimaxillary protrusion, and relatively flat mid-face; (B) 2-year postoperative view of correction with columella strut and premaxillary augmentation with septal cartilage autografts. Mentoplasty and malar augmentation have also been accomplished with prefabricated silastic implants. |
The lack of immune response, the proven longevity, and the physical and structural characteristics which make cartilage so easy to handle and contour, have made cartilage autografts so desirable. In nasal reconstruction, because of the limited amount of grafting material needed and the easy accessibility of septal and conchal cartilage, autogenous cartilage is the preferred grafting material. In areas where large grafts are needed, such as the chin and cheek, the need to obtain such grafts from the rib, which require significant additional surgery and resultant morbidity, is a deterrent. In addition, the excellent host acceptance to preformed allografts in areas other than the nose have reduced the use of cartilage autografts in these other sites. The surgeon should be familiar with the varied grafting materials available to him in addition to cartilage autografts. In planning and considering the aesthetic improvement of facial features, it is important to incorporate these varied materials in his armamentarium (Figure 18).
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