Is Rib cartilage recommended for primary rhinoplasty?

Question

If i want to get my bridge higher, is it recommended to get rib cartilage for primary rhinoplasty or should i go with silicone implants?

Jacob Sedgh, MD · Answer

Thank you for your question! It depends on the patient and the results they are looking for. Even though cartilage is used more often in revision rhinoplasty, it can also be used in a primary rhinoplasty; for instance, in major post traumatic cases and saddle nose deformities. Speak with your surgeon and make sure that you are both on the same page with what you're trying to achieve. We wish you the best!

Kian Karimi, MD, FACS · Answer

Unfortunately, without a picture to assess, it is difficult to determine if a graft is needed for your rhinoplasty. During a primary rhinoplasty, cartilage grafts can be taken from the septum itself, but if there is not sufficient cartilage, ear or rib cartilage can be utilized. Going forward, I would recommend you to complete multiple in-office assessments with board certified plastic surgeons so that they may assess your septal cartilage and determine whether additional grafts are necessary to achieve your desired aesthetic goal.

Lucian Ion, FRCS · Answer

To answer this question, it matters to know how low is the bridge to begin with and how high you want in the end. It depends of course if you also want to change the tip.
Photo simulations can help you with this decision.
For a smaller enhancement, silicone implants or ePTFE can be adequate. This change can be very well simulated with injectable fillers to help you decide before committing to surgery.
Rib cartilage can produce more structure and definition to the bridge, but it is more complex. If you are looking for a more chiselled appearance of the bridge or if the projection of the bridge is very low to begin with, in my experience, rib cartilage offers some advantages.

Zoran Potparic, MD · Answer

Without in person evaluation and/or good series of photos, it is impossible to give you meaningful advice. In general, if large augmentation of dorsum is needed, rib cartilage graft may be best option (or fresh frozen cadaver rib cartilage). However, moderate and small augmentations can be treated with septal cartilage grafts, possibly with addition of fascia graft. In the hands of an experienced surgeon, rib cartilage graft is safe procedure and that per se should not be your major concern. Second and third opinion consultation is recommended. Good luck.

Toby Mayer, MD · Answer

Rib cartilage or septal Cartlage for primary rhinoplasty. in my experience of 45 years of rhinoplasty and thousands of noses I have never had to use rib cartilage for a primary rhinoplasty! Rib grafting is painful and much more expensive! See several very experienced rhinoplasty surgeons who can show you natural results of their noses without rib

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. For dorsal augmentation, I recommend diced septal cartilage wrapped in fascia rather than rib or a silicone implant. Silicone implants in the nose have an extremely high complication rate including malposition, extrusion, and infection. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and not just a computer animation system. You should be able to view numerous pictures of actual patients with noses similar to yours performed by your surgeon. If you cannot find enough real before and after pictures, then consider continuing your search for a surgeon. Best wishes and good luck.

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

Ronald J. Edelson, MD · Answer

a silicone implant has the benefit of simplicity compared to the cartilage graft.   plastic surgeons are all over the map with which they think is best. Go on severalConsults. Maybe you don’t need the graft at all.

William Portuese, MD · Answer

Is always best to use nasal cartilage first is the primary graphing source for rhinoplasty.  Ear cartilage and Rib would only be used if there's not enough nasal cartilage available

Serhan Derin, MD · Answer

Firstly, augmentation amount should be assessed, because, if this amount is minimal, septal cartilage can be enough to fill the dorsum. And we usually don't need rib cartilage to fill the nasal dorsum in primary cases. The situation whether we need rib cartilage to fill the nasal dorsum or not should be examined carefully in preoperative period. If extra cartilage to fill will be in need during the rhinoplasty procedure, it may be provided with silicon or rib cartilage. It should be kept in mind that silicon material has higher risk of infection than rib cartilage. But these two materials can be used in the rhinoplasty if need.
Best wishes.

Barry L. Eppley, MD, DMD · Answer

The question you are asking is a classic one...whether significant nasal dorsal augmentation is better done by a rib graft vs an ePTFE nasal implant. (not pure silicone) Successful outcomes can be achieved with either technique and there is no right answer one way or the other. When two surgical techniques can achieve similar results (same advantage) the decision comes down to which of their disadvantages can you live with the best. Implants avoid a harvest site and scar, offer a smooth uniform result and save operative time (and cost to you) but always have a higher risk of infection. Rib grafts have a minimal risk of infection but can develop warping/asymmetries, require a harvest site, longer recovery and increased costs.

Is Rib cartilage recommended for primary rhinoplasty?

Answers (12)

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