Becker Rhinoplasty Center
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DR BECKER IS NOW TREATING RHINOPLASTY PATIENTS BY TELEHEALTH.

During the COVID-19 state of emergency, in order to protect our patients and staff, but in order to communicate with patients and plan for the future, Dr Becker will communicate with potential rhinoplasty patients by Telehealth. Telehealth appointments may be scheduled on the phone (our operators our working remotely). Visits will be performed by audio or video discussion.

Becker Rhinoplasty Center
Central New Jersey
609-436-5740
Southern New Jersey
856-772-1617
CONTACT US
CENTRALNew Jersey
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  • Meet the Doctor
  • Procedures
    • Rhinoplasty
    • Revision Rhinoplasty
  • Photos
    • Bulbous Tip
    • Droopy Nose
    • Ethnic Rhinoplasty
    • Finesse Rhinoplasty
    • Nasal Bump
    • Nasal Fracture
    • Narrow Nose
    • Overprojected
    • Revision Rhinoplasty
    • Saddle Nose
    • Twisted Nose
    • Underprojected
    • Unique Issues
    • Upturned Nose
    • Wide Nose
  • Testimonials
    • Patient Reviews
    • Testimonial Videos
  • Videos
    • Testimonial Videos
    • Educational Videos
  • Patient Education
    • Nose Form & Function
    • A Patient’s Guide
    • Books & Publications
    • Revision Rhinoplasty Textbook
    • Rhinoplasty Education
    • Rhinoplasty Dissection Manual
  • Locations
    • Sewell Office
    • Voorhees Office

Chapter 12 – Harvesting Conchal Cartilage: Anterior Approach

Auricular cartilage can be harvested using the anterior or posterior approach (1-6). In most cases, we prefer the anterior approach because we believe it is less traumatic, and the incision heals well if vertical mattress closure is used. If smaller cartilage grafts are needed, then we use the posterior approach.

With a marking pen, outline an incision that follows the outer edge of the cavum and cymba concha. This incision should he placed along the portion of the concha that is vertically oriented in relation to the lateral aspect of the skull (Fig. 1). Use a syringe with 1% lidocaine (Xylocaine) solution with 1:100,000 epinephrine (or for the lab demonstration, water) to “hydrodissect” the skin of the concha cavum and cymba from the underlying cartilage.

Make the incision with a no. 15 blade, and elevate the skin and perichondrium from the underlying cartilage. Dissection proceeds by using appropriate scissors, and also bluntly with cotton-tip applicators. Care should be taken not to damage the soft auricular cartilage, which can tear. The dissection should stop short of the cartilage of the external auditory canal. The radix helicis should be preserved if preservation of ear position is critical. If the entire conchal bowl in excised, the auricle will usually settle closer to the head.

Dissect out the desired piece of cartilage, and leave the underlying muscle behind (perichondrium will remain adherent to the posterior surface of the cartilage). Avoiding deep dissection into the soft tissue minimizes bleeding.

Suture the circumferential incision with a 6-0 nylon running mattress suture. Alternatively, the incision may be closed with interrupted vertical mattress sutures. Special care must be taken to avoid overlap of the skin edges. Place a bolster dressing of Telfa, dental roll, or other suitable material into the concha, and suture it into position to decrease the risk of hematoma. No residual deformity of the pinna is expected with this approach.

Becker Rhinoplasty Book
Figure 1 A
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Figure 1 B
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Figure 1 C
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Figure 1 D
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Figure 1 E
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Figure 1 F
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Figure 1 G
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Figure 1 H
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Figure 1 I
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Figure 1 J
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Figure 1 K
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Figure 1 L
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Figure 1 M
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Figure 1 N
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Figure 1 O
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Figure 1 P
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Figure 1 Q
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Figure 1 R
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Figure 1 S
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Figure 1 T

Figure 1. A-T: Injection hydrodissects the skin of the concha cavum and cymba from the underlying cartilage (A). The incision follows the outer edge of the cavum and cymba concha and is placed along the portion of the concha that is vertically oriented in relation to the lateral aspect of the skull (B, C). Dissection proceeds by using appropriate scissors, and also bluntly with cotton-tip applicators (D—G). The dissection stops short of the cartilage of the external auditory canal. Incise the cartilage (H, I) and dissect out the desired piece of cartilage (J, K). Achieve perfect hemostasis before closure (L). The cartilage should be handled gently to avoid tearing or damaging the soft auricular cartilage. Suture of the circumferential incision is shown here with a 6-0 nylon running vertical mattress suture (M-P). Alternatively, one may close the incision with interrupted mattress sutures. Place a bolster dressing of Telfa, dental roll, or other suitable material into the concha and suture it into position (Q-T) to decrease the risk of hematoma.

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REVIEWS

"Dr. Daniel Becker is the sweetest most caring person. It’s almost a year since I had a really bad nose bleeds and he was there for us, came to hospital in the snow on a Sunday just to fix me. He is so very special and always there when you need him. Love him!!!"

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