I will be having a revision rhinoplasty done and my doctor wants to use banked rib cartilage. Is this a good idea? He states that using my own is very risky due to other complication that might arise. What are the positives and negatives using banked rib cartilage?
Is It a Good Idea to Use Banked Rib Cartilage?
Doctor Answers (5)
Irradiated cartilage is a form of banked cartilage that is often used for rhinoplasty especially in secondary or tertiary ones when the patietn does not have enough septal cartilage or does not want to have her own rib cartilage used. It is usually very safe. I have writen a paper on this subject in the plastic surgery literature and I am in the process of writing a book chapter on it as well.
Use of Banked Cartilage for Rhinoplasty
The use banked cartilage is safe and long-term studies have shown it to be effective and durable. It does resorb and can warp, so it requires a great deal of experience to get good results. Rib cartilage is a viable option, however, it entails additional OR time and a second incision. The main risk is injury to the lung but in experienced hands, this should be unlikely. The third option is an allograft such as Medpor. Depending on the reconstruction, it can be very effective.
If your surgeon only wants to use banked cartilage and you feel uncomfortable, you should seek a second opinion, if for nothing other than to feel more comfortable with your surgeon's recommendation. You should never go to the operating room unless you have complete confidence in your surgeon.
Using "Banked" Irradiated Rib Cartilage
This is a very common question regarding revisionary rhinoplasty and the need for additional cartilage. Banked cartilage is from a cadaver (via organ donation) which is then treated with radiation to help remove any "cells" leaving only cartilage behind. This is a easy source of cartilage (it comes off the shelf), but there are high rates of resorption with this approach. You body will recognize some of the microscopic components of this as "foreign" and slowly break down this cartilage over time. Results are much more likely to change and erode with this technique.
The alternative is to use your own rib cartilage as there is no response to your body from this approach - it's your own tissue. Harvesting this cartilage does require an extra incision and some postoperative pain, but the results will likely be much longer lasting. This technique is well proven and very safe. The last thing you want to do with revision rhinoplasty is have a second, unwanted surgery relating to the progressive loss of cartilage that could have been prevented. Discuss this in detail with your surgeon to help understand all of the details.
See and experienced rhinoplasty surgeon.
Best of luck,
Vincent Marin, MD
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The question of banked cartilage has always been it's longevity. Several recent studies of long term results (see Dr. Kridel) have shown excellent longevity. It seems that as long as it is not being used for total structural support but augmentation that it lasts well. Using your own isn't that much more risky, but it does add more operative time and discomfort which for some patients is significant.
Is it a good ide to use banked rib cartilage for Rhinoplasty
I have performed Rhinoplasty for over 20 years and IMHO, NO...banked cartilage, bone from rib, ear or wherever dissolves unevenly over 5-15 years and should never be usde in Rhinoplasty...again, IMHO. Your own cartilage and bone will also dissolve unevenly but at a slower rate. Do a google search on uneven absorption of irradiated (banked) and rib cartilage in Rhinoplasty as this subject has been well reserched in the plastic and cosmetic surgery literature and has been for many years. I recall reading papers, on this subject, in the mid 1980's so I am always amazed that Rhinoplasty surgeons continue to use this material. I have taken out many, of these grafts, placed elsewhere during Revision Rhinoplasty.
For nasal tips, conchal cartilage is the best and for the nasal dorsum...I prefer septal cartilage or a straight silastic implant. Hope this helps.
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