There are three types of cartilage used in revision rhinoplasty. The first choice is always cartilage from the septum, as it is straight, firm cartilage which does not require harvesting from outside of the nose. In cases where septal cartilage has already been used during previous surgery, the next choices are ear and rib.
Ear cartilage can be excellent for certain smaller grafts but tends to be weaker than septal cartilage and may not be strong enough for reconstructing noses which require major support.
Rib cartilage can also safely and effectively be used in revision rhinoplasty. The cartilage can be autologous, which means that it comes from the patient, or irradiated, which is donated by an individual who is deceased. The harvest of rib cartilage is done through an inconspicuous 2-3 cm incision, which can be tucked under the right breast in women. The first risk related to harvesting this cartilage is injury to the underlying lung or tissue layer around the lung, called the pleura. This can result in air being introduced around the lung, what is known as a pneumothorax. This extremely uncommon complication can be managed by temporary placement of a chest tube for a few days following the procedure. Other risks related to rib cartilage include the grafts becoming visible under the skin, shifting of the grafts, and resorption, or dissolving of the grafts. This risk of resorption is thought to be greater when the cartilage is irradiated (cadaveric cartilage). In general, use of rib cartilage is extremely safe and for surgeons who specialize in revision rhinoplasty, the benefits of utilizing rib cartilage greatly outweigh these risks.