Despite my previous attempts to achieve a normal range of symmetry in my nose, I've not been very successful thus far and am therefore considering completely rebuilding my nose using rib/costal cartilage. When it comes to costal cartilage, if the cartilage warps, is it difficult to revise? Should I use my own rib cartilage for the bridge or should I use implanted materials with which my body has done well with in the past? (Silastic, Goretex) to reduce chances of warping?
What is the Best Material/combination of Material to Completely Rebuild a Devastated Nose?
Doctor Answers (7)
Best Material to Rebuild Nose
I always prefer to use the patient's own cartilage when reconstructing the nose. My first 2 choices are septal and ear cartilage but this does not sound like this is possible for you. You can avoid warping when using rib on the bridge by placing diced cartilage in a fascial sheath.
Rebuilding a nose
If your nose truly requires a "total rebuild", then your own rib cartilage will be the best material to use. Detailed preparation, carving, shaping etc should really minimize the risk of warping and you will never have to worry about implant infection or extrusion.
To rebuild a "devastated" nose I feel that your own rib cartilage is best
For nasal reconstruction, there are a number of options to rebuild noses. The first choice is septal cartilage then ear then rib cartilage. However, ear cartilage is soft and good for volume but not strength and structure. Rib can warp but usually more so when used to rebuild the bridge of the nose and not to straighten the nose. There are ways to also rebuild the bridge with less chance of warping. For that I used diced cartilage in fascia. Your cartilage is diced up and placed in your own natural tissue called temporalis fascia.
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Best Material to Rebuild the Nose
In a case of severe over-resection or trauma, when the nose has to be rebuilt from the inside, the best option is always tissue from the patient. If a significant amount of structural grafting is needed, then rib (costal) cartilage is very useful. Though there can be problems with warping, as you mention, steps can be taken during the procedure to help reduce this. In my practice, I prefer this over implant materials. Also, as others have mentioned, some cases may be appropriate for a diced cartilage in fascia (DCIF) approach, especially for dorsal augmentation.
I'm sorry to hear about your experience. The best would be to have an in-person consultation with a board certified specialist who can help you. It will be important to have a thorough evaluation of the inside and outside of your nose to determine how best to reconstruct it. If rib cartilage is used, it needs to be prepared in a way to minimize the potential for warping as you don't want to undergo yet another surgery later. I would advise staying away from foreign materials as they can be rejected, move, or become infected. There is also other options to reconstruct the nose with a smaller chance of warping. Please do your research and seek out a board certified specialist in the face who can assist you and guide you towards achieving the results you seek.
Implant choice on nose
It is really up to you and your surgeon to decide which implant is best. I personally an not a fan of the silicone or medpor nasal implants. I prefer cartilage whether from the patient or irradiated from a cadaver. They can warp, and they can be revised.
- We use rib cartilage if we need to completely rebuild a nose
- You can also use irradiated rib cartilage which is treated cartilage from someone else that warps less often compared to your own rib (and you avoid a scar)
- If it warps, it may need to revised and usually it is a minor procedure depending on how much and if it does warp
- I would avoid plastic materials in the nose as they can get infected or extrude (come through the skin), especially in a revision nose where the skin is not as thick and has a poorer blood supply