Heard Bad Things About Rib Cartilage Rhinoplasty, What's the Risk?

I use only your own tissues to make the bridge along your nose. In over 300 Asian rhinoplasties using your own tissue, I have only needed to use the rib in one case. Prior to that, I used silicone implants but currently prefer ear cartilage. If performed properly, you can have the proper bridge height without going through a rather large operation. Most patients only require a few millimeters of height, and in my opinion it is overkill to harvest a rib for this.

Yes, a rib operation is as big as it sounds.

As with any technique, there is a learning curve.  Rib rhinoplasty represents one of the more challenging operations in rhinoplasty as the surgeon has to not only carve the portion of rib cartilage, but also anticipate any further changes.  For this procedure, it is best to seek the expertise of an experienced rib rhinoplasty surgeon.  There are many poor rhinoplasty results with rib cartilage due to the skill level required.  However, there are many poor rhinoplasty results with silicone, medpore, auricular cartilage, etc.  The surgeon is the key factor here.

 

With that being said, rib rhinoplasty does not mean cartilage taken from the rib has to be placed on the bridge.  Often times, the septal cartilage can be placed along the bridge with the rib cartilage used to help project the nasal tip and define it.  When used properly, rib cartilage can be performed so that the results are subtle, elegant, and natural.  

 

Using rib cartilage is a good option for patients who want to use their own tissues and require significant dorsal augmentation. Some of the risks include unpredictable outcome due to warping of the cartilage and donor site problems including chest scar deformity. 

Rib cartilage is a good option to raise the bridge in Asian rhinoplasty though there are risks that the cartilage will warp or shift. Of course there is a chance that an implant can do the same. Take time to discuss both options.

There are risks and benefits to every surgery. In general, risks of augmentation rhinoplasty include malposition of the graft and possible infection. There is a risk that a cartilage graft could warp and the rib graft carries additional risks specific to the harvesting of the graft. Those risks include prolonged operating time, an additional procedure, possible pneumothorax which may require hospitalization for treatment and also hematoma or seroma. Nonetheless, the rib graft can be an excellent source of cartilage for augmentation rhinoplasty. If the graft is handled properly, excellent results can be expected.

I feel it is best to use the patient's own tissue rather than a silicone implant to augment an Asian nose, but  over the past 35 years I've rarely used rib cartilage. It can warp with time and is much more difficult to harvest. There is adequate cartilage in the nasal septum and the ear.

Hi,

Consider doing a silastic implant instead of rib cartilage. There 2 large studies published in the Archives of Facial Plastic Surgery that confirmed silastic implants as the choice for Asian rhinoplasty and dorsal augementation. Rib cartilage can sometimes warp or look too bulky. See link below for examples.

Best,

Dr.S.