Rib or Ear Cartiledge to Increase Nose Bridge Height and Tip?

Rib cartilage is a good choice when either a lot of cartilage is needed or particularly strong or straight cartilage is needed. Ear cartilage is a different type of cartilage (elastic cartilage) than septal or rib cartilage and has its own limitations in terms of amount and pre-existing curvature. Ears can be fairly sore as can rib, but careful technique and good post-op meds can keep patients a lot more comfortable.
[And with all due respect to my colleague below, Gore-Tex for augmentation of the dorsum was described even earlier by Dr. Stephen Rothstein (two years earlier), in 1989: Rothstein SG and Jacobs JB: The Use of Gore-tex in Nasal Augmentation Surgery. Ear, Nose and Throat Journal 40-45, September 1989.]

You've brought up some excellent questions. Ear cartilage is easier to harvest during the surgery, but it isn't as thick as rib bone or cartilage and may tend to warp more. Rib cartilage is harvested with a small incision, and if your surgeon puts some long lasting numbing medicine after harvest, your pain should be at a minimum. Although, if you really need to build up the bridge a lot you may not have enough ear cartilage and you'll have to use rib instead. Good luck!

Hi Natalie,
If you have not had previous septoplasty then you should have enough septal cartilage to give you adequate augmentation of your nasal dorsum. Septal cartilage is least likely to warp. Your surgeon can use ear cartilage if more material is needed.
Choose your rhinoplasty surgeon most carefully.
Good luck.
Dr. P

Generally the ear cartillage is 2-3 mm thick and a double layer will only accomplish 4-6mm of augmentation. Therefore other techniques have been developed to increase the augmentation by rolling it or dicing and placing it within an absorbable sleeve.
The rib cartilage can easily be 10 mm in thickness and can accomplish a greater enalrgement for the bridge but is less generally less preferable for the tip.
The septum is the ideal choice for the nose, especially the tip but occasionally does not provide adequate material for the bridge.

Warping is actually less with ear cartilage but ear cartilage has a higher rate of reabsorption. Increasing bridge height is best done with a rib graft. In order to decrease chances of warping, a technique called concentric carving is utilized. This means that the outer layers of the rib are carved down, leaving the central part of the rib for use as a graft. This has been found to markedly decrease the rate of warping when using rib. One of the challenges with using septal and ear cartilage for bridge augmentation is that there is usually not a sufficient amount to provide one long segment over the bridge. You then end up using several different fragments of cartilage jointed together, which is a piecemeal approach. In my opinion, this is a suboptimal approach compared to using one continuous segment of concentrically carved rib cartilage. With regard to pain, ear cartilage harvesting does hurt but typically is not as bad as the pain associated with rib harvesting. There is definitely a tradeoff between the two procedures. In either case, pain is usually well controlled with low dose narcotic medication and subsides within the first week.