Major Risks of Revision Rhinoplasty Using Rib Cartilage?

Doctor Answers (16)

Use of rib cartilage in revision rhinoplasty

+3

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.


Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 26 reviews

Rib grafts are a good option

+2

If the nose needs structure, then the first place the surgeon looks is inside. However this usually isn't an option because the loss of cartilage/bone is the reason the surgeon is looking for material. Therefore we go farther a field. First the ear or both ears, then the rib. We used to use the skull and before that, the pelvis.

The problems with rib are the extra site of surgery, possible local complications (although these are rare), and the quality of the cartilage is different than the nose and not as good unfortunately.

Oakley Smith, MD
Toronto Facial Plastic Surgeon
5.0 out of 5 stars 25 reviews

Rib Cartilage

+2

Rib cartilage is most often used in nasal surgery when a larger amount of cartilage is needed. In experienced hands the potential complications are minimized. If I personally needed a rib graft for my revision rhinoplasty, I would have the procedure without hesitation. For a list of specific possible complications, ask during your consultations.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

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Rib cartilage for rhinoplasty

+2

Rib cartilage is often used in rhinoplasty for patients that need augmentation of their nasal bridge. Harvesting the rib is fairly straightforward. It will leave a permanent scar on the chest that is usually no more than a few inches long. The biggest complication from the harvest is a potential for a pneumothorax ( collapsed lung).

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Rib Cartilage Grafting for Revision Rhinoplasty

+2

In revision rhinoplasty, it is usually necessary to reconstruct and reshape the nasal framework using cartilage grafts. Because available septal cartilage has usually been removed during the first surgery, grafts must obtained from either another site - the ear or the rib.

Rib cartilage has many uses and advantages in revision rhinoplasty. It can be carved or shaped to the desired configuration. Its rigidity can provide support to a weakend nasal framewoek.

Drawbacks of Rib Cartilage Include:

  • Rendency to warp (curve). This can make the result unpredictable.
  • Nose may feel firm or inflexible.

Potential Risks of Rib Cartilage Harvest:

  • Bleeding
  • Scarring
  • Pain
  • Infection
  • Collapsed lung (pneumothorax)
  • Chest wall deformity

However, in experienced hands, rib cartilage allows successful results in revision rhinoplasty.

C. Spencer Cochran, MD
Dallas Facial Plastic Surgeon
5.0 out of 5 stars 89 reviews

Risks of revision rhinoplasty using rib (costal) cartilage

+2

The risks are generally low when performed by an experienced surgeon but they can include (and are not limited to):

infection, bleeding, hematoma, wound breakdown, hyperftrophic or keloid scar formation, contour irregularity, hemo/pneumothorax, graft resorption or warping, overcorrection, undercorrection, graft rotation/extrusion/exposure, inability to acheive a specific funtional and/or cosmetic result.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 44 reviews

Rib graft for rhinoplasty

+1
Using the rib as a source of cartilage for rhinoplasty is a great option. It offers a large amount of cartilage that can be used to reconstruct the nose. The main risk if the risk of collapsed lung, which is a serious risk that may require a chest tube. However, the risk is very low (I have never see it happen in my practice and not even in my training during residency or fellowship). The other risk that sometimes worries people is pain. Rib grafting used to be associated with significant pain, but with some simple changes in technique, the pain can be quite minimal. Most patients tell us that the pain is not an issue at all.

P. Daniel Ward, MD
Salt Lake City Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

major risks of rhinoplasty using rib cartilage

+1
  It is important to use patient's own nasal cartilage first for grafting purposes. If the nose has been depleted of cartilage, consideration for ear cartilage as the next best source. If the ears have been depleted or are not adequate, then consideration for using rib cartilage can be entertained. Rib cartilage can tend to warp years  after it has been placed in the nose, the donor site usually can be quite tender for several months afterwards and patient's have a very small risk of  pneumothorax during the procedure.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 55 reviews

Revisions Rhinoplasty with Rib cartilage

+1

Revision rhinoplasty presents many challenges, including where to find cartilage to rebuild important structures. Most surgeons use septal cartilage as a primary material. If not available ear cartilage is the next choice.

When a large amount of cartilage is needed, and the septum and/or ear are not sufficient, rib is the next logical material. Even then we have the choice of using a patients own rib, or obtaining cadaver rib instead. Both can be effective. Great care must be taken to carve the rib grafts, and to minimize the warping which can occur. When needed, this can be an excellent material.

Ira D. Papel, MD
Baltimore Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Rib cartilage is commonly used for revision rhinoplasty

+1

Rib cartilage is a common source for revision rhinoplasty. My first choice would be septal cartilage (from inside the nose). If there is not enough cartilage, I like to use ear cartilage using an incision behind the ear. Sometimes, this is not enough cartilage, and rib can be used with a high level of safety, in the right hands. As with any surgery, there are some risks which your surgeon can discuss with you. 

Dr. Zoumalan

Richard A. Zoumalan, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 12 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.