Costal Cartilage Graft Overtime?

Dear RBrownBH, The perfect graft in revision Rhinoplasty would be completely risk free, have no complications, be easy to harvest, and offer predictable results.  Costal cartilage grafts are generally used when a large amount of cartilage is required for grafting and/or there is insufficient alternative sources (septum, concha bowl) available.  Therefore rib grafts, which have been used for various purposes for many years, offer an acceptable solution to the problems presented by revision Rhinoplasty.  Like any surgical procedures, there are risks which you have alluded to in your question.  However, autologous costal cartilage grafts offer significantly less infection or extrusion risk in Rhinoplasty than synthetic grafts.

Thank you for the great question. Using autologous (from you) rib in rhinoplasty is not a particularly new practice. It has been a technique in reconstructive surgery for decades. The prominent use of rib cartilage in cosmetic rhinoplasty is a somewhat more recent phenomenon.  The long-term complication that is most feared with costal cartilage grafts is warping -- or shape change/curvature of the graft material over time. Certain techniques are used in surgery to limit this, but it is unfortunately not completely predictable. That being said, the alternatives in cases where a significant amount of grafts are needed are less appealing. With implants in the nose, there is a risk of infection and extrusion over time, in addition to the risks of settling or shifting. This is not an easy decision, but, in my opinion, using your own tissue is always better.
 

Costal cartilage can warp over time, but it depends what the cartilage is going to be used for and how it is going to be used in the nose.  For example, diced costal cartilage has a very low likelihood of warping.  Please consult with a board certified specialist who can assist you in achieving the results you seek.

  It is always best to use nasal cartilage for revision rhinoplasty as  your primary source  for grafting and reconstruction. if the nose has been depleted of cartilage, then consideration for ear cartilage is the next step.    Rib cartilage can be used however it can have issues, such as warping,  feeling very stiff and it does ossify  and become hard  with the aging process

Hi

All cartilage grafts have risks.  They are natural tissue.  Skin, bone, cartilage, fat, all change over time.  Your face continues to change from 25 to 80.  If you did nothing to your nose and never got a nose job, your nose would be different at 80 than it is at 25.  So the people who recommend implants such as silicone are very short sighted.  Implants have lots of risks and their risks are much more serious than just warping or calcifying.  There is no perfect graft.  Septal cartilage is the best out of all the sources for rhinoplasty but its not 100% perfect.  Rib cartilage is very good but it takes years of experience with it, knowing how to carve it and how to place and secure it.  Too many plastic surgeons just take a piece and do a little rudimentary carving then shove it in the nose and hope for the best.  It takes finesse.  Probably no one has as much experience with Rib cartilage than Dr. Dean Toriumi in Chicago.  Ear cartilage has an inherent weakness in its shape and its not a good source whatsoever for the bridge.  Its ok for the tip at times but septum cartilage and rib cartilage are usually better.  

Costal cartilage grafting has been in use for many years.  Its use has diminished due to the resulting chest scar and potential for warping/migration.  In experienced hands, it can still be used successfully.  Because of the scar, I generally prefer septal or ear cartilage before considering the ribs.  In most patients, there is an abundance of cartilage in either of these 2 locations. Costal cartilage yeilds large grafts, which are usually reserved for congenital or traumatic defects, or severe cosmetic complications.  I would recommend consultation with a board-certified Plastic Surgeon, who has a particular interest in rhinoplasty.

The use of rib cartilage grafts in nasal surgery is not truly a new procedure. We know that it is more likely these grafts will warp depending on where they placed and whether or not they are diced or used as strips. This is the reason I prefer to use septal or ear cartilage. It is very rare for any cartilage graft to shift or erode through the skin. Calcification is not an issue.

 Yes and you can do a medline search at a library and read the articles that describe the uneven absorption of rib cartilage grafts in Rhinoplasty.  This is why I don't use them.  Hope this helps.

Hi,

Costal cartilage grafts can warp over time. The can also look uneven if not shaped correctly or put in the right tissue plane. Consider a custom carved silicone implant. It looks and feels natural and if you ever have a problem with it, they can easily be removed. See link below.

Best,

Dr.S.