I am going for a revision rhinoplasty and my doctor is telling me the best he can do if I have enough cartilage in my nose. He is against ear or rib cartilage as he states the nose will be unnatural and stiff. He is able to create a better nose if he were to use ear or rib cartilage if he really had to right? What is the difference between a revision done with cartilage from the nose verses cartilage from ear or rib?
Why Might a Doctor Not Want to Use Ear or Rib Cartilage?
Doctor Answers 12
Cartilage Grafting in Revision Rhinoplasty
The preferred source for cartilage in revision rhinoplasty is highly dependent on the correction needed. Septal, auricular and rib are all the first choice for different reconstructive problems. For simple revisions, septal cartilage is best. I also prefer it for applications where I want a straight piece of cartilage. For areas where I want a curved graft, such as the nasal tip, I prefer ear cartilage. If a large volume graft is necessary, rib is preferred.
Great surgeons have the ability to think on their feet. With reconstructive and revision surgery one never knows exactly what will be found until the incision is made. Your surgeon needs to be facile at using multiple reconstructive options to get you the best result. I would be leery of someone that only uses one method. You wouldn't hire a carpenter that fixed everything with a hammer, why would you want a surgeon with the same approach.
Cartilage grafts for revision rhinoplasty
If your surgeon is truly "against ear or rib cartilage" then I suspect it's because he isn't experienced in using them. That's a very worrisome sign. No one who does a lot of rhinoplasty is categorically against using a patient's own tissue. While septal cartilage is best, ear and rib also have important uses in the nose.
All the best,
Consult another BOARD CERTIFIED PLASTIC SURGEON
Ear and Rib cartilage grafts are used extensively with good results
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Choice of graft
Without seeing your photos it is difficult to comment. Although most surgeons like using septal cartilage as a graft there are many situations where septal cartilage is actually not the best option. An experienced revision surgeon should keep all options open.
Cartilage donor sites for grafts with revision rhinoplasty (nose job)
Replacing" like with like" is a generally desireable goal in plastic surgery. This means it is best to use local tissues that are most similar to the area being reconstructed. The cartilage of the nose is unique in its thickness and pliability. The ear and the rib are significantly thicker and less pliable than the native nose cartilage making them more difficult to shape or mold. Furthermore, it requires a distant and separate donor site each associated with its own unique set of risks.
Cartilage Used in Revision Rhinoplasty
Septal Cartilage is my first choice in rhinoplasty surgery, followed by cartilage from the ear and ribs. Rib cartilage is my last choice because it is more difficult to harvest. Make sure your surgeon does a lot of revision rhinoplasties.
Revisoin rhinoplasty often incorporates cartilage grafts if possible. These can often be found in the septum but sometimes require ear or rib cartilage. Sometimes surgeons use other products to avoid the complications associated with harvesting the cartilage.
Cartilage for Revision Rhinoplasty
Cartilage grafts are often used in revision rhinoplasty. If available, the best cartilage to use is septal cartilage followed by ear and rib cartilage. Ear cartilage is softer and more malleable than septal cartilage but is a good second option. Rib cartilage is the hardest and can be used as well but needs more carving and if not shaped properly it can show through the skin and feel hard.
Cartilage options for revision rhinoplasty
The septum is the first choice for use in rhinoplasty for several reasons, however in revision rhinoplasty the septum may be unavailable or insufficient. Revision rhinoplasty is often a more difficult procedure - the surgeon should have the skills necessary to do the best job. Sometimes that requires use of ear or rib cartilage.
Best Cartilage Graft Sources for Nose Surgery
Regarding: "Why Might a Doctor Not Want to Use Ear or Rib Cartilage?
I am going for a revision rhinoplasty and my doctor is telling me the best he can do if I have enough cartilage in my nose. He is against ear or rib cartilage as he states the nose will be unnatural and stiff. He is able to create a better nose if he were to use ear or rib cartilage if he really had to right? What is the difference between a revision done with cartilage from the nose verses cartilage from ear or rib?"
Successful surgery is a delicate dance between risks and benefits. In addition, just like an experienced builder knows which materials would work best in certain situations so do experienced surgeons. There is NO doubt that if you have sufficient available septal cartilage in your nose that it is a far better material (especially since it is already in the area being worked on) than other sources. For this reason, most nose surgeons would look at septal cartilage first, ear cartilage second and rib cartilage third as grafting sources for nose surgery.
Dr. Peter Aldea
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.