i recently met a plastic surgeon for consultation.. he said that my septal cartilage may be insufficient and said costal cartilage is a better alternative than ear for my tip and alar correction. i heard it first time. since i was last pt and he was busy we scheduled another visit next week.. but before i would want to know more about the costal grafts...please help me understand it better.thank you for your valuable opinions.
Costal Cartilage Grafts Sounds Scary..need More Information? (photo)
Doctor Answers 7
Cartilage grafts for rhinoplasty
The real question here is whether or not you have a cartilage depleted nose from a prior surgery. If that is the case, indeed further options will need to be explored, such as ear cartilage grafting, rib cartilage, or synthetic silastic implants. If the septum has not been operated upon, then chances are quite good that there is more than enough cartilage left in the nose to perform the task of rhinoplasty.
Costal cartilage is rib graft. It offers the most graft material for use and is often used for dorsal nasal grafts.
Is rib cartilage recommended in rhinoplasty.
Rib cartilage is indicated for structural grafting (nasal dorsum, caudal septum reconstruction, columellar strut grafts, alar batten grafts) only when there is not enough septal cartilage remaining. Although ear cartilage can be used for these applications, it does not resist compressive or bending forces as well. Rib cartilage is less useful as a shaping material such as a tip graft due its stiffness.
Harvesting rib cartilage is a straight forward procedure if done by an experienced surgeon. The risks associated with rib cartilage harvest are very low in the hands of an experienced surgeon. Postoperatively the donor site will be moderately painful for 1 or 2 weeks afterwards. There will be a small 2 to 3 inch scar on your chest wall. Solid rib cartilage does have a well recognized long term problem of warping in a certain percentage of cases.
It is difficult to make a decision based on photographs but in general, rib cartilage is not used in primary rhinoplasty unless one wishes to achieve major dorsal augmentation.
Mario J. Imola, MD, DDS, FRCSC.
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When to use rib cartilage for rhinoplasty!
Most patients who have not had previous nasal surgery can get good results with septal or ear cartilage grafts. There are circumstances when large volumes are necessary where a rib graft makes sense. In general the rib grafts are stiff and unnatural when used in the tip. Ear or septal cartilage has a much softer and more natural feel. For that reason I would recommend trying to avoid the rib if not absolutely necessary. There is also the concern that harvesting the rib does mean longer surgery, more expense, and some risks related to the harvest. The use of cadaver rib can also be considered if your surgeon feels it is appropriate.
Rib cartilage grafts
It all depends what you want to achieve. If your nose is too small, or short, or "snubbed", then you will need a fairly stiff graft to extend the tip. Septal cartilage is best, but if not enough is available then rib cartilage is the next best option. Ear cartilage is too soft and pliable to be of use for structural purposes. It sounds like your surgeon is capable of harvesting and using rib cartilage, and although your chest wall will be sore for several days, most patients are fine at one week. I have done about 100 rib grafts from patients, and have used several hundred tissue-banked (donor) rib cartilages.
However if the discussion is about "refinement" and small changes then rib cartilage would not be necessary.
Rib Cartilage in Rhinoplasty Surgery
Over the last 35 years I've rarely used rib cartilage in rhinoplasty surgery, especially in the nasal tip because it typically results in a very firm tip. I prefer septal cartilage; however if this is not possible, I will use ear cartilage. After reviewing your picture I feel that it is unnecessary to harvest from the ribs which post operatively is much more difficult for the patient.
Costal Cartilage Grafts and Rhinoplasty
Thanks for your question and photos. Best of Luck!