What would be some of the advantages of using rib cartilage as opposed to a prosthesis when undergoing revision rhinoplasty to reshape the bridge of my nose?
Advantages of Rib Cartilage over Prosthesis?
Doctor Answers (13)
Rib Cartilage Grafts are Preferable to Implants in Most Nose Reshaping Cases
Thank you for the great question. Using autologous (from you) rib in rhinoplasty is not a particularly new practice. It has been a technique in reconstructive surgery for decades. The prominent use of rib cartilage in cosmetic rhinoplasty is a somewhat more recent phenomenon. The long-term complication that is most feared with costal cartilage grafts is warping -- or shape change/curvature of the graft material over time. Certain techniques are used in surgery to limit this, but it is unfortunately not completely predictable. That being said, the alternatives in cases where a significant amount of grafts are needed are less appealing. With implants in the nose, there is a risk of infection and extrusion over time, in addition to the risks of settling or shifting. This is not an easy decision, but, in my opinion, using your own tissue is always better.
Autologous versus synthetic grafts in rhinoplasty
Your own tissue will become integrated into your nose far better than an implant or prosthesis. Consequently, rib cartilage has a far lower rate of infection, extrusion or migration than a synthetic implant does.
Few advantages of rib cartilage over prosthesis
The only advantage rib cartilage has over a prosthetic implant in the nose is that the rib is the patient’s own natural tissue. However, nasal cartilage should be harvested before attempting a removal of rib. Ear cartilage would be the second choice prior to going to rib. If the nose and ears are cartilage depleted, then rib graft can be considered. Disadvantages of using a rib graft are warpage, and an unnatural hard wood-like feel to the nose. It is also difficult to remove a rib graft from the nose. Another disadvantage of rib grafting is the risk of a pneumothorax when harvesting the cartilage. The advantages of synthetic silastic implant are that it is easy to shape and remove if it ever needs to be removed. Rarely do synthetic implants made of silastic get infected.
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Rhinoplasty with implant or cartilage
this depends on the surgeons preferance and experience. the prosthesis can actually be carved and shaped to customize it for your nose. not all doctors do this.
cartilage can warp and the surgeon must be comfortable harvesting the rib. it is useful for large and complex reconstructions and more resistant to infection
Rib Cartilage vs Prosthesis in Revision Rhinoplasty
Over the past 35 years I've always preferred to use the patient's own tissue in revision rhinoplasty. Synthetic prostheses are more likely to move, extrude, or become infected, especially when placed in scarred tissue with less than ideal circulation.
You have several options for improving the appearance of your nasal bridge after previous Rhinoplasty Surgery.
If you had a previous rhinoplasty and want your nasal bridge "reshaped", you may be a candidate for a Non-Surgical Rhinoplasty procedure with Injectable Fillers. These may be used to raise the height of your bridge, or to fill indentations that may have occurred. My personal preference is to use Silikon-1000, an off-label filler for permanent results.
Rib cartilage is advocated by many reputable rhinoplasty specialists, but I do not use this when performing Rhinoplasty Surgery. I have attended lectures by the "best" physicians using rib cartilage, and have noted some examples of overcorrection, or a bridge that looks too high.
When performing rhinoplasty in a patient that requires a higher bridge, I prefer to use a synthetic ePTFE (formerly GoreTex) graft that is custom carved in the OR to suit the particular patient's needs. There is a small risk of infection or extrusion of ePTFE implants (5%), or misplacement. The majority of my patients that received ePTFE implants are thrilled by their results.
I hope this helps you.
Rib cartilage for nose
Autologous tissue( your own tissue) ia lways better than synthetic. Less risk of infection and extrusion.
Rib Cartilage vs Artificial implant
The choice of implant is determined by what needs to be done, even in revision surgery. Whether a rib cartilage graft, gortex, silicone, septal or auricular cartilage is used depends on what needs to be done.Each patient has his/her own set of circumstances and needs custom planning as far a implant material. Rib grafts have disadvantages as well. It also depends on what your surgeon is comfortable using. So try not to get hung up about implant material as much as finding the right surgeon for your revision.
Revision rhinoplasty rib vs synthetic implants.
Rib cartilage over implant for nasal revisions
I try never to use foreign materials for nasal revisions. Your own tissue will get blood supply and be resistant to infections and be solid in position. implants can get infected later on, move etc. I know some doctors like implants in that area, but I disagree.
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