Rhinoplasty: Q&A
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Rib or Ear Cartiledge to Increase Nose Bridge Height and Tip?
I was wondering which method has a less warping rate for rhinoplasty: Rib or Ear cartiledge. I want to increase my bridge height and my tip but only wanting to use my rib as last resort because of the scarring and pain. So i'm hoping to use both my ears and septum if i have too. However i heard that using both ears is actually more painful then extracting rib.. is this true? What are your thoughts.
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17 Doctor Answers |
Asked by
Natalie2010x
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First choice for reconstructing the nasal bridge is septal cartilage
The first choice for reconstructing the nasal bridge is always septal cartilage. If you have not had a previous septoplasty there is usually plenty of cartilage available to adequately build up the nasal dorsal height. In some Asian noses there may not be enough cartilage present, and occasionally synthetic implants are used to augment the bridge. These are made of Silastic plastic. The rib cartilage is only used after the nose cartilage and ear cartilage has been depleted. Yes, there...
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Consider an implant as alternative to rib or cartilage for Rhinoplasty
In my experience, rib grafting is the best procedure to heighten the nasal bridge or correct a "saddle nose". I have also iused a calvarial bone graft taking bone from the skull-less pain and recovery than the rib graft and well hidden scar.
Ear cartilage just does not have the firmness and substance to reconstruct the nasal bridge effectively in my experience.
If you are adamant about avoiding scars and pain from the harvest of bone, non-autologous (artificial) implants are...
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Rib can warp, but done carefully it's likely to work well.
Rib cartilage is a good choice when either a lot of cartilage is needed or particularly strong or straight cartilage is needed. Ear cartilage is a different type of cartilage (elastic cartilage) than septal or rib cartilage and has its own limitations in terms of amount and pre-existing curvature. Ears can be fairly sore as can rib, but careful technique and good post-op meds can keep patients a lot more comfortable.
[And with all due respect to my colleague below, Gore-Tex for augmentation...
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Rhinoplasty and grafting
You've brought up some excellent questions. Ear cartilage is easier to harvest during the surgery, but it isn't as thick as rib bone or cartilage and may tend to warp more. Rib cartilage is harvested with a small incision, and if your surgeon puts some long lasting numbing medicine after harvest, your pain should be at a minimum. Although, if you really need to build up the bridge a lot you may not have enough ear cartilage and you'll have to use rib instead. Good luck!
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There are many options for increasing your nasal bridge height
Rib and Ear cartilage are the most natural ways to increase the height of your nasal bridge. Rib cartilage has the advantage of having an abundant supply of cartilage. Their is a tendency to warp and this can be prevented by placing pins inside the rib or by equal carving on all sides of the graft. There are other ways to prevent the warping as well. Ear tends to get absorbed more than rib and also is not as resilient and has a natural bend to it. It really depend on the person whether...
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Rhinoplasty; What is Best Graft Material for Augmenting Nasal Dorsum
Hi Natalie,
If you have not had previous septoplasty then you should have enough septal cartilage to give you adequate augmentation of your nasal dorsum. Septal cartilage is least likely to warp. Your surgeon can use ear cartilage if more material is needed.
Choose your rhinoplasty surgeon most carefully.
Good luck.
Dr. P
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Cartilage donor sites
If you need a fair amount of dorsal elevation, I would probably use rib cartilage graft. It is thicker than ear cartilage and can give more elevation of the dorsum. As per warping, both can warp.
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Pain not a concern - use what works best!
It really depends on how much augmentation you need. Ribs can warp, but rarely do if "concentric carving" is performed. I use rib cartilage about twice per month, (ear cartilage weekly) and can say that neither is painful, generally. If harvested via a "muscle splitting" technique through a small incision, most patients say the chest does not hurt. The ear site hurts a bit, but really only when one lies on it at night. Therefore, the key determinant should really be the...
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Septum (septal) and ear (conchal) and rib (costal) cartilage grafts for the nose
Generally the ear cartillage is 2-3 mm thick and a double layer will only accomplish 4-6mm of augmentation. Therefore other techniques have been developed to increase the augmentation by rolling it or dicing and placing it within an absorbable sleeve.
The rib cartilage can easily be 10 mm in thickness and can accomplish a greater enalrgement for the bridge but is less generally less preferable for the tip.
The septum is the ideal choice for the nose, especially the tip but occasionally...
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Ear and septum first choices
In most cases ear cartilage harvesting and use is easier and equaly useful as using a rib graft. I would keep the rib harvesting for extreme cases with marked deviation, or in the need for major tissue reconstruction.
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Rib vs Ear Cartilage for Rhinoplasty
Septal and ear cartilage are my first two choices in augmentation rhinoplasty. Harvesting ears is definitely not more painful than making a chest incision to take rib. Although very rare, complications during or after taking ribs can be more severe. However, ribs are an excellent choice when necessary.
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Rhinoplasty Rib Grafting
Warping is actually less with ear cartilage but ear cartilage has a higher rate of reabsorption. Increasing bridge height is best done with a rib graft. In order to decrease chances of warping, a technique called concentric carving is utilized. This means that the outer layers of the rib are carved down, leaving the central part of the rib for use as a graft. This has been found to markedly decrease the rate of warping when using rib. One of the challenges with using septal and ear cartilage...
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That is not true!
You will get enough height normally from the septum/and or 1 ear cartilage. It is much more painful and usually not necessary to do a rib graft.
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Surgiform, ePTFE grafts work well to increase the bridge of your nose.
You should consilt several certified, experienced Rhinoplasty surgeons before going ahead with your procedure. I routinely use nasal-septal cartilage grafts to improve the nasal tip, but I've never been a fan of using cartilage to enhance the bridge. I was trained to use ePTFE (formerly Gore-Tex) to increase the bridge. It's fairly easy to sculpt, and leads to predictable, natural results. There is a small chance of infection / extrusion which is less than 5%.
I've attached a photo...
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Rib or Ear Cartilage for Rhinoplasty
The rib has more warping than ear cartilage and definitely hurts more even if both ears are used for cartilage harvest.
However, depending on the amount of augmentation needed you might be better off with a rib cartilage.
Another important thing to ask your surgeon is, 'what does he feel more comfortable doing?' Its more important that the surgeon using the technique which she or he is really well versed with.
Pain and scarring with both is a minor issue because at the end of the day what...
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Nasal augmentation
A lot will depend on how much you need. You can sometimes stack cartilage grafts to achieve the desired results without the need for rib grafts. Other times with severe deformities you need a rib graft to achieve adequate correction. As far as warping is concerned it is more of a problem with rib grafts in my experience.
This is something you need to discuss with your plastic surgeon as he/she may have an opinion which way to go to give you the best result.
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Rib Cartilage as a last resort
Actually I prefer Gore-Tex for the dorsum as I was the first to describe the use of this material in 1991. When possible I will always use septal cartilage as a first alternative when enough is available and obviously depending on how much augmentation is needed. My second choice for the dorsum of the nose is Gore-Tex but remember that some of the injectable implants like Radiesse or Perlane are now part of the discussion . I reserve use of rib grafts for very severe saddle nose...
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