Does Ear and Rib Cartilage for Nasal Tip Rhinoplasty Warp or Get Reabsorbed over Time?

Nasal cartilage is always the best primary grafting material for any tip augmentation.  Ear cartilage is the secondary material and rib cartilage is used when there is no ear or nasal cartilage left.  Ear cartilage is stiff compared to nasal cartilage and makes the nose feel more firm than normal.  Rib cartilage is rigid and tends to make the nose feel very hard and woody.  Rib cartilage has a very bad tendency to warp but usually does not get resorbed.  Synthetic implants are only placed along the bridge and are compose of silastic.  Synthetic implants should never be used in the tip of the nose. 

Synthetic implants are very seductive and attractive since they are of perfect shape and come out of the box without the need for surgical harvest. Used in the tip area they will almost always become extruded or infected requiring removal. On the dorsum some may do well for many years and never have a problem. Others may shift or also extrude.

Septal and ear cartilage will not warp, resorb or be extruded and will survive. Rib cartilage has a small chance of warping which is minimized by carving and using the central component. Cartilage will also feel more natural in the nose.

The best alternatives for tip support and projection in rhinoplasty are septal cartilage and ear cartilage. Both are stable and will not reabsorb and resist warping. Rib cartilage is a third choice as it is more difficult to obtain, and may have more tendency to warp. Synthetic materials are good, however there are ever present risks of infection or exposure of the implant.
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peterejohnsonmd