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.

 You will get enough height normally from the septum/and or 1 ear cartilage. It is much more painful and usually not necessary to do a rib graft.

You should consilt several certified, experienced Rhinoplasty surgeons before going ahead with your procedure. I routinely use nasal-septal cartilage grafts to improve the nasal tip, but I've never been a fan of using cartilage to enhance the bridge. I was trained to use ePTFE (formerly Gore-Tex) to increase the bridge. It's fairly easy to sculpt, and leads to predictable, natural results. There is a small chance of infection / extrusion which is less than 5%.
I've attached a photo demonstrating ePTFE bridge enhancement.
I hope this helps, and best regards.

The rib has more warping than ear cartilage and definitely hurts more even if both ears are used for cartilage harvest.
However, depending on the amount of augmentation needed you might be better off with a rib cartilage.
Another important thing to ask your surgeon is, 'what does he feel more comfortable doing?' Its more important that the surgeon using the technique which she or he is really well versed with.
Pain and scarring with both is a minor issue because at the end of the day what matters to you is the shape of your nose.
Regards

The first choice for reconstructing the nasal bridge is always septal cartilage. If you have not had a previous septoplasty there is usually plenty of cartilage available to adequately build up the nasal dorsal height. In some Asian noses there may not be enough cartilage present, and occasionally synthetic implants are used to augment the bridge. These are made of Silastic plastic. The rib cartilage is only used after the nose cartilage and ear cartilage has been depleted. Yes, there is indeed a fair amount of warpage that can occur with rib cartilage. Ear cartilage does not tend to warp as much, but ear cartilage can be rather firm, fixed, and hard feeling in the nose.

Rib and Ear cartilage are the most natural ways to increase the height of your nasal bridge. Rib cartilage has the advantage of having an abundant supply of cartilage. Their is a tendency to warp and this can be prevented by placing pins inside the rib or by equal carving on all sides of the graft. There are other ways to prevent the warping as well. Ear tends to get absorbed more than rib and also is not as resilient and has a natural bend to it. It really depend on the person whether ear or rib hurts more. In my experience, rib grafting is far more painful than ear harvesting.
One option for nasal bridge augmentation is using silicone implants. They are very compatible to our tissues and are almost the ideal implant. You don't need an extra place to harvest it and can last for as long as you live without absorption, warping, and the need for another area to harvest. The argument against silicone is that is not natural and can lead to infection but there are data out there that shows the rib cartilage can have just as high of a rate for infection during rhinoplasty / nose shaping / nose jobs.
Thanks for reading!