im really concerned that my rib columella strut will resorb. why are doctors' opinions so different on this issue? i requested to my surgeon maybe we could use a implant in the tip. he says that i will get infection. i want this to be my final revision rhinoplasty but i am just so confused on this issue.
Doctor Answers 7
Rib cartliage graft
Most rib grafts do not resorb after they have been placed in the nose. When a rib graft is placed as a columellar strut it will make the nose much more firm, woody, and hard. Infection in the nose from a rib cartilage graft is very rare.
Resorption of rib
Autologous (obtained from your body) rib cartilage rarely resorbs whereas cadaver rib cartilage may resorb either partially or completely - especially if infected. Synthetic Implants in the tip/columella are best avoided if possible.
Rib cartilage does absorb unevenly
I have performed Rhinoplasty for over 20 years and it was common knowledge back in the 1980's when I trained that rib cartilage, rib bone and bone from the outer table of the skull all dissolved and did so unevenly. This has been reported in the scientific litearature, so I am also surprised when I read and hear about Rhinoplasty surgeons using this material.
IMHO, the following materials are the best:
- Conchal ear cartllage for the nasal tip
- Silastic straight dorsal implants for the nasal bridge***septal cartilage can be used for the bridge but typically it's not long enough to cover the entire length of the nasal bridge.
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Rib cartilage resorption
When your own cartilage is used I have found that graft resorption is very rare. A more common problem with rib cartilage is when cadaveric rib is used, though reports by some surgeons do show very good long term graft take with this product as well.
I agree with avoiding synthetic implants (e.g. medpore) in the tip as I prefer using your own tissue, though some surgeons are proponents of its use.
Rib cartilage for rhinoplasty
There are two reasons cartilage grafts resorb: inadequate blood supply and inadequate fixation. If your surgeon is recommending rib cartilage I assume that a significant structural defect exists. If not, there are less biologically "costly" options available, such as ear or septum.
Revision rhinoplasty can be difficult due to scaring in what is otherwise a very delicate space. Make sure your surgeon has enough experience in this type of undertaking to maximize the chances for a good result.
Rib cartilage and septal cartilage can resorb a bit. Usually they hold up very well for the long term.
Rib Cartilage Strut Graft
Cartilage grafts can reabsorb however its very rare. Typically strut grafts are taken from septal cartilage, ear cartilage and rib cartilage as a last resort. Resorption can happen when grafted cartilage does not get an adequate blood supply after surgery. It can also happen if the harvesting technique is traumatic to the cartilage. So there are many factors to cartilage survival that are out of the surgeon or patients control.
Artificial implants in the tip are not a good idea unless the surgeon has alot of experience with this type of implant.
If you post your pictures, you would probably get a better answer on what to do.