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.
Rib or Ear Cartiledge to Increase Nose Bridge Height and Tip?
Doctor Answers 17
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 is indeed a fair amount of warpage that can occur with rib cartilage. Ear cartilage does not tend to warp as much, but ear cartilage can be rather firm, fixed, and hard feeling in the nose.
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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 available for raising the nasal dorsum during rhinoplasty.
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 of the dorsum was described even earlier by Dr. Stephen Rothstein (two years earlier), in 1989: Rothstein SG and Jacobs JB: The Use of Gore-tex in Nasal Augmentation Surgery. Ear, Nose and Throat Journal 40-45, September 1989.]
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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!
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 ear or rib hurts more. In my experience, rib grafting is far more painful than ear harvesting.
One option for nasal bridge augmentation is using silicone implants. They are very compatible to our tissues and are almost the ideal implant. You don't need an extra place to harvest it and can last for as long as you live without absorption, warping, and the need for another area to harvest. The argument against silicone is that is not natural and can lead to infection but there are data out there that shows the rib cartilage can have just as high of a rate for infection during rhinoplasty / nose shaping / nose jobs.
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Rhinoplasty; What is Best Graft Material for Augmenting Nasal Dorsum
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.
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.
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 amount of material required, and what areas of the bridge need to be augmented. Hope this helps some.
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 does not provide adequate material for the bridge.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.