Ear and Rib cartilage are used in varying percentages depending on the problem. In primary rhinoplasty, ear and rib are less common unless there is some reason why the septum is not a good donor site for the cartialge required. In secondary rhinoplasty, the percentage of ear and rib goes up, probably on the order of 15 to 50 % depending on the problem and previous surgery. Many times in secondary rhinoplasty, the septum has not been touched so this becomes a good donor site.
What Percentage of Rhinoplasties Need Cartilage Grafts from Ear or Rib?
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Grafts from other sites for primary rhinoplasty
Whether grafts are needed from sources other than the nose depends on how much support or augmentation is needed and how much septal cartilage is available. With asian rhinoplasty need for ear or rib grafts approaches 50%. In this example there was need for major tip support and the septal cartilage was inadequate.
Use of rib or ear cartilage for rhinoplasty
I have never had to use rib or ear cartilage for a primary rhinoplasty with a patient who has had no trauma or cocaine use. The cartilage from the septum is adequate.
These cartilages are used more often for secondary or multiple previous surgeries.
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Small percentage of rhinoplasties need cartilage grafts from ear or rib
Very few primary rhinoplasties need ear cartilage grafts or rib cartilage grafts. Ear and rib cartilage is only used after the nose and septum have been depleted of excess cartilage. Patients who undergo revision rhinoplasties have a higher chance of needing cartilage grafts from the ear or rib.
Each grafting source provides unique advantages
In my practice, I use septal cartilage in about 90% of the time, ear cartilage about 30% of the time and rib cartilage about 30% of the time. The decision of which source to use (and sometimes I will need to take from more than one site) depends on a few things:
1. How much overall material I will need. As a surgeon who uses a structural philosophy, I tend to need more material in order to keep the nose strong while aesthetically balanced. Rib provides the most material, but does involve more time and recovery. Septal cartilage is usually the best first choice, unless a large augmentation is needed (for example to raise the bridge a lot).
2. The type of material needed. For example, ear cartilage is curved and springy. This does not work well when you need strong or straight cartilage grafts. But this type of cartilage is ideally suited to provide curved support for certain areas of the nose like the outer wall.
3. The availability of cartilage in any given site. This is important especially during revision rhinoplasty. When previous surgery has been performed, there may not be graft material available in the septum or even the ear.
Percentage of grafts for rhinoplasty
I can not give you a definite number or percentage of how many rhinoplasty patients need ear or rib cartilage. If grafts are needed they are usually obtained from the septum. If they are secondary procedures, they may need to be taken from the rib or ear.
Percentage of Rhinoplasties with Cartilage Grafts
I'm not aware of any national statistics on the percentage of patients who need cartilage grafts with rhinoplasty surgery. In our practice, it is very high because 60% of our rhinoplasty patients are having revisions of surgery done before we've seen them. Some ethnic groups, such as Asians, need cartilage augmentation with their primary surgery. It is fair to say that cartilage grafting is very common.
It is hard to give you a percentage. Most rhinoplasty patients can have cartilage used from their nasal septum unless they have had a previous septoplasty. If a patient has had a septoplasty then the next logical place to obtain cartilage if needed would be from the ears. In my opinion I reserve the use of rib cartilage for major reconstructive rhinoplasty.
Percentage of rhinoplasties needing cartilage grafts
Of the total rhinoplasties done I would venture a guess of less than 10% need ear cartilage or any cartilage grafting. I always save septal cartilage in case I need a graft.
From MIAMI Dr. B
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