Rib graft is not necessary in most cases only when the nose is really collapsed. Other methods can be used including implants, ear cartilage and septal cartilage which are much less surgery.
There are a variety of methods to increase dorsal height: Solid cartilage grafts from the septum, ear or rib, bone grafts, diced cartilage wrapped in temporalis fascia, and synthetic implants. Each has advantages and disadvantages. The currently preferred method is with diced cartilage for the dorsum and solid cartilage grafts for the tip. Synthetic implants have a significant long term complication rate and are usually not favored by plastic surgeons with extensive experience in performing nasal procedures.
Following the advice from a
surgeon on this or any other website who proposes to tell you exactly what to
do without examining you, physically
feeling the tissue, assessing your desired outcome, taking a full medical
history, and discussing the pros and cons of the operative procedure would not
be in your best interest. I would suggest you find a plastic surgeon with
extensive nasal surgery experience who is certified by the American Board of
Plastic Surgery and ideally a member of the American Society for Aesthetic
Plastic Surgery (ASAPS) or a facial plastic surgeon (ENT) that you trust and are
comfortable with. You should discuss your concerns with that surgeon in person.
Robert Singer, MD FACS
The nasal bridge can be augmented using bone, cartilage, or a silicon implant. I almost never perform this except in reconstructive cases or previous rhinoplasty. I have never done this in a primary rhinoplasty. Nasal bridge grafts are very difficult to get to look good. It may sound like an appealing idea, but unless this is being done for reconstruction such as a trauma case, I would probably advise against it even without seeing photos.
Cartilage grafting may be the best option, but there are a huge number of techniques to address any one issue.
Kenneth Hughes, MD
Los Angeles, CA
I use diced cartilage wrapped in fascia to increase dorsal height and solid cartilage in the tip which is harvested from the septum or the ears. For 35 years I've avoided the use of silicone and synthetic implants because of the increased risk of infection, movement, or extrusion.
Raise dorsum and lengthen nose. To lengthen the nose depending how much a composite graft of skin and cartilage from the ear is required. See an experienced rhinoplasty surgeon.
Hi and thanks for your question. With 30 years experience in rhinoplasty, I still prefer the use of a patient's own tissue for rhinoplasty as results are more predictable and with much less chance for infection. Diced cartilage wrapped in temporal is fascia is well tolerated and results in a significant and stable increase in dorsal height. The tip is also best defined by a combination of cartilage carving methods, sutures, and cartilage tip grafts when needed. It is usually not necessary to use a patient's rib cartilage as one's own ear cartilage is a great source and creates no deformity with a much simpler recovery. If ear cartilage isn't available then rib cartilage is the next logical choice. Make sure you seek out a surgeon with experience in rhinoplasty as this is one of the most challenging aesthetic procedures. Best of luck!
Provided there is no need for restoring structural support to the cartilage/bony dorsum (ie. relatively intact nasal bones and septum), a diced rib - temporalis fascia cylindrical graft is currently the ideal method to augment the dorsum. If significant dorsal support is necessary then solid rib is the best choice. In order to increase nasal length a solid cartilage reconstruction of the dorsum and caudal septum are necessary. Depending on the degree of desired tip definition and the skin thickness, options to increase tip definition include: cartilage tip graft (more powerful) versus suture tip-plasty (less powerful). It sounds that you are referring to revision rhinoplasty in the over-resected nose...if so, the maneuvers you are seeking are some of the most challenging goals is rhinoplasty, so your expectations need to be realistic.
Mario J. Imola, MD, DDS, FRCSC.