What percent of rib grafts warp after revision rhino? If warping does occur, what is the period of time this can be expected?

Hello,
Thank
you for your question. Rib grafts warping is not uncommon situation.
They can be warped in months and decades. When rib grafts are used,
it is possible for you to have warping .And this wrapping can easily
be treated with revision rhinoplasty surgery so ; we are performing
some techniques such as scoring and stitching that prevent them
from warping in time and we also cover the ribs with fascia that
helps prevent warping too.
Best
wishes and good luck

Bora
Ok, MD - Plastic, Reconstructive and Aesthetic Surgeon

hello thank you for your question and provided information as well.. based in your question its difficult evaluate you if the case dont have a picture, my recommendation is get  a consultation in person with a plastic surgeon to discuss all about theme.

Textbooks have photos of rib cartilage bridge grafts that warped decades after they were placed. The thought used to be that leaving the cartilage covering of perichondrium on one side caused the graft to bend as the perichondrium contracted. Some surgeons "bruise" ear cartilage or crush it so it does not warp. Rib cartilage is harder so some surgeons dice it and insert the diced cartilage into a sock of tissue that is then placed in total as the graft. Treatment of the inverted-v is usually spreader grafts, which lie in a different position than bridge grafts for bridge augmentation. The spreader grafts are sutured into position between the septal and lateral cartilages. In this position it is unlikely they could warp as opposed to bridge grafts that are placed on top of the septal cartilage and nasal bones and are more likely to warp.

There are many factors in rib grafts warping over time mostly related to your actual ribs as well as the technique utilized in carving and splinting the cartilage grafts.  
Younger patients typically have more warping than older patients due to increased calcifications within the cartilage as we get older.  However, regardless of age, one can see warping of rib cartilage.  It is important to harvest the graft early in the operation to observe for warping tendencies as the operation progresses.  In many cases it is useful to see the warping occur during surgery so that different segments can be selected appropriately.  Cadaveric rib grafts have less tendency to warp but can resorb over time and many surgeons will reserve them for use in patients that are not a candidate for rib graft harvest.
Most importantly with rib grafting, you want to make sure that your surgeon has adequate training and experience with carving rib grafts to optimize your result.  Good luck!

Hi,
There is always a chance for some warping of an implanted cartilage rib graft. It is less likely to warp if it is your own rib vs. a radiated rib from someone else. The fact that you have very thin skin makes it more likely to see any imperfections of the rib graft and makes any even slight warping to be more noticeable.
I suggest you get several surgical opinions before deciding who you choose to do the procedure. I would choose someone who does many rib grafts.
Thank you for your question.

I would wait three to four months after the placement of a rib graft to the nose that has warped before revising it by either further graft shaping or converting it into a diced graft.

Transplanted cartilage can misbehave and that can spoil an otherwise great rhinoplasty. You may be lucky enough to be a candidate for a filler instead of another surgery. That will require a consultation of course and also the consulting doctor reviewing all your records including photos. So, " bring everything" to the consultation and be sure to have computer imaging to see the predicted result of either a surgical revision or non-surgical revision rhinoplasty. Best wishes.Robert Kotler, MD, FACS

Warping occurs with cartilage graft from the ribs. The exact percentage depends on the technique used. There are ways to minimize and counter the effects of warping. It's hard to say without seeing you or seeing photos to know what needs to fixed and how warping may affect the results. Consult a rhinoplasty specialist to have a detailed discussion about this applies to YOU specifically. Best wishes.

Thank you for this question.  The surgeon you have seen is correct: rib grafts can warp.  That being said, a number of factors play into the warping to include your age, the quality of your cartilage, certain technical factors of your surgery, etc.  I would recommend that you see a Board certified plastic surgeon to review these factors as they apply to you.