Either option is reasonable. Implant versus rib cartilage.
if you're looking for a result that is fairly dramatic but you prefer cartilage then rib cartilage is necessary. However, using an implant on the dorsum that is only for the dorsum and does not extend to the tip is a very good option for many patients. An many of my own patients I prefer implant for the dorsum and then ear cartilage for the tip and columella support. Your profile does have a fairly little bridge so I would agree that if you want cartilage for the bridge rib would be required. All that being said there are many cases where I have done the bridge and the tip and all of the rhinoplasty work with the ear cartilage from both ears and no other material. It is typically a situation where the dorsal augmentation is subtle so my need for cartilage is less.
Chase Lay, MD
Double board-certified facial plastic surgeon
Asian Facial Plastic Specialist
My preference would be to use diced cartilage with temporalis fascia to achieve a smooth, natural appearance. Implants have the additional risk of moving, getting rejected from the body, and infection. Rib cartilage will not warp if it is diced and prepared prior to placement in the nose. Please consult with a board certified specialist who can assist you with achieving the results you seek.
Rib Cartilage - it depends how you use it for Asian Rhinoplasty
My bias is to use diced cartilage and deep temporalis fascia to build the dorsum of the nose. I have used this technique to save multiple infected implants and for primarily building the dorsum (bridge) for patients who do not want an implant. I am not totally against silicone implants, but they just don't look so natural to me in the long run. But there are many surgeons who will use ear cartilage to make the columellar strut and then augment the bridge with silicone implants. Not a bad choice, but not my favorite.
Options for dorsal augmention with Asian rhinoplasty
The safest, most permanent option for building up your nose is using tissue from your own body. Any synthetic implant will always have a higher risk of infection, migration or extrusion than your own tissue (such as ear cartilage or rib cartilage).
Rib cartilage can certainly warp if used as a large piece, but when used as a diced cartilage fascia (DCF) wrap, it can provide predictable, straight and natural appearing augmentation (building up of the bridge). The most consistent results, however, come from the surgeon, not the technique.
Implant or Rib Cartilage to Augment Asian Nose
For the past 35 years I have avoided implants to augment the dorsum of the Asian nose whenever possible because of the possible risk of infection, movement, or extrusion. Diced rib cartilage will avoid the risk of warping but it will be necessary to make a chest incision. I prefer to use the patient's own tissue such as diced septal and/or ear cartilage wrapped in fascia.
Rhinoplasty and dorsal augmentation
You need dorsal augmentation. Choices include your own cartilage( rib most likely), irradiated cartilage, or an implant. There are pluses and minuses to each.
Asian rhinoplasty recommendations
The goal of most Asian rhinoplasty is to achieve a more refined look that is still Asian and not Caucasian. I would recommend a dorsal implant using the Rizzo nasal implant from Implantech. This is a slim but natural looking silicone implant that only sits on the dorsum but does not augment the tip. Because it places no tension on the tip infection or extrusion is hardly ever a problem. It creates a higher bridge without looking unnatural. I would never recommend a L-shaped silicone dorsal implant as augmenting the tip with silicone implants can cause the tip to thin and the implant to be visible or extrude over time. The tip should be augmented with ear cartilage as the first choice. Rib cartilage can be used as a last choice if the ears have insufficient cartilage from previous rhinoplasty attempts. Harvesting rib cartilage is much more painful and has a more visible donor site scar. Rib cartilage can also warp or shrink if placed as a dorsal implant. I would also reduce the upper part of the lower lateral cartilages to slim your tip as well as a conservative alar reduction to slightly narrow your nostrils. Finally you have a bit of mid-face retrusion (i.e. a flat face) I would recommend a Brinks Peripiriform implant which is inserted at the base of the nose to increase mid-face projection. I believe these changes will bring a more balanced and improved aesthetic appearance to your face. All of these changes can be previsualized using the Vectra XT 3D simulation system. You can see more before and after on my website at drbenjaminchu.com