How likely is rib warp or cartilage shrinking?

Question

How likely is this? Does it all depend on the patient’s nose/scar tissue/etc.? I’m hoping for a revision to give my nose back its tip and length and I am a little nervous for the possibility of the cartilage shrinking or the rib warping (if I’d need rib). And if anyone has experience with this please let me know.

Alejandro Nogueira, MD · Answer

I'll try to clarifiy concepts I think may be of the greatest help for you and readers:
-rib
 cartilage is an excellen kind of graft, has no substitute whenever the 
surgeon needs thick, strong or long grafts or when other donor sites are
 for whatsoever reasons unavailable; however it is not the first choice 
in structure and revision rhinoplasties in the vast majority of cases 
(its morbidity involves a visible scar at the chest a a somehow painful 
couple of weeks after surgery, besides the time consuming procedure to 
harvest it and the technical skills required)
-in afroamerican and
 asian rhinoplasties of primary type rib cartilage is required in 90% of
 cases; in revision rhinoplasties (non ethnic) the percentage of rib 
cartilage usage is way smaller, I'd rate it 20-30% cases
-genuine or predominantly african and asian noses the use of rib can be cosidered the rule, so in your case it was good decision
-harvesting
 a rib cartilage is technically challenging, the surgeon has to be 
careful not to produce a pneumothorax or a pleural tear, and its 
tayloring is tricky: only the core, center or shaft of the rib cartilage
 is usable, since it is the straight part which remains straight, the 
cortex of the rib cartilage warps and has to be discarded as first 
instance (although there are trick to use it like joining 2 warped 
cortex portions facing each other like parenthesis); as a rule and 
regarding the build up of a dorsum in afroamericans or asians, or saddle
 nose deformities in revisions, the shaft of the cartilage is the block 
we shape and taylor for the nose; failing to use ONLY the shaft leads to
 warping, this is a well known fact many decades ago and still some 
surgeons fail to comply with this technical standardSeek the advice and hands of a serious professional who offers to you a time-consuming and expensive procedure; stay far from minimally invassive snake-charming procedures, synthetic implants, fillers, wrapped diced cartilage, etc.
See the link below to find few cases of my own practice very similar to yours which I had the opportunity to operate successfully on, sharing a lot of common features with the technical problem you have posted.
If you wish better grounded opinion well lit, focused and standard images have to be assessed: frontal, both lateral and both oblique views, also from underneath.

Scott Trimas, MD · Answer

Rib cartilage is the ideal source for obtaining additional cartilage to strengthen the underlying nasal structure when septum is no longer available or insufficient in quantity. Ear cartilage is also an option. Rib cartilage warps very little over time and seems to occur in about 1.5 to 2% of all rhinoplasties where this type of graft is used. Good technique is important as well as proper placement.  I personally have not had any patients warp their cartilage over time.

Thomas A. Mustoe, MD, FACS · Answer

Cartilage grafts are the ideal grafting material. They do need to revascularize, and it is extremely rare to see shrinkage if taken from the patient's own rib.  Warping can be minimized with proper technique but hard to completely eliminate in all cases.  For a variety of reasons including warping, wrapping finely diced cartilage in a fascia wrap offers advantages in many cases.

Paul N. Afrooz, MD · Answer

There is always the possibility of cartilage warping, but there are several ways to control and reduce the chances of this happening.  This has to do with the way the cartilage is is cut and fashioned, and how the grafts are placed at the time of the procedure.  Choosing a plastic surgeon who has experience and expertise in revision rhinoplasty is also extremely important because he or she will understand all of the nuance when it comes to preventing cartilage warping.

How likely is rib warp or cartilage shrinking?

Answers (4)

Answer: Cartilage Warping

Answer: Cartilage Warping

Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.

How likely is rib warp or cartilage shrinking?

Answers (4)

Answer: Cartilage Warping

Answer: Cartilage Warping

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Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.