Pros and cons of ear and rib grafts?

Question

What's are the risks of harvesting cartilage from my ear or my rib? Which type of cartilage has more tendency to wrap over the years? Which type of cartilage would you suggest for my revision if I need major tip reconstruction, spreader grafts and bridge augmentation? And I was wondering if septal cartilage grafts can also wrap over time? Thank you very much!

P. Daniel Ward, MD · Answer

I much prefer rib grafts  over ear cartilage grafts  due to the cartilage being more rigid and more plentiful. In addition, it can be better shaped for the individual nose.  Ear cartilage grafts are useful in the right situation, but are not as useful, in my opinion, for major revision cases.

Myriam Loyo, MD · Answer

Hi there,You have a great question about the materials used in rhinoplasty.When available, septum is the preferred material by many surgeons. The advantage it has is that you can harvest it during the rhinoplasty and the material matches the cartilage already in your nose well. Septum cartilage is easy to reshape and the thickness is idea. The main limitation is that it is often not enough for a complex reconstruction or a revision. When the septum is not available, a surgeon might suggest cartilage from the rib or the ear. Sometimes your surgeon might suggest a synthetic material. Rib cartilage is a great option for rhinoplasty. The advantages of rib cartilage are that it is strong and enough  material is available for a complex reconstruction. Rib cartilage ideal for dorsal augmentation as you can get a straight piece to augment the whole bridge. Rib cartilage can be obtained from your own body or can be donated. When the cartilage is donates, it comes from a cadaver and it is cleaned and irradiated to prevent any infection transmission. The disadvantages for rib, are harvesting the cartilage and a tendency for the cartilage to curve.  If rib cartilage is being harvested from your own chest requires more time under anesthesia, an extra incision, and adds to your own recovery. We call the tendency to the cartilage to curve, warp. The risk of warping is less than 1% and surgeons shape the rib cartilage in a special shape to avoid warping (cutting out the edges, only using the center, evaluating the shape, etc). Even with the greatest care, warping can occur, but it is a rare occurrence. It is worth mentioning that our own cartilage calcifies as we age, so in older patients (usually over 45) your surgeon might recommend donated cartilage so that the cartilage is more flexible. Ear cartilage can also be a great option for rhinoplasty. Ear cartilage is most often takes from the concha of the ear, which is the curved part of the ear in the center. So the shape of the ear does not change significantly after harvesting. The advantage of using ear cartilage is that is can be easily harvested, it is generally strong cartilage, and sometimes the curvature can be used to its advantage. I particularly like the ear cartilage to reconstruct the lateral ala of the nose (meaning the curved part of the nasal tip). The main disadvantage is that it can sometimes be insufficient for a complex reconstruction. It is not my preferred graft for the dorsum. Some surgeons use it in the dorsum by dicing the cartilage finely (cutting up into very small pieces) and making a smooth cartilage "putty" or "pat'e". Finally synthetic material has the advantage of being abundant and readily available. You can make synthetic materials in any shape you require. Synthetic materials have the disadvantage that if they get infected they often need to be removed. As synthetic materials have known to extrude many years (even 10 years) after surgery. I generally try to avoid using a synthetic material.I hope you find all this information helpful.I gave you a lot of detail! Discuss with your surgeon what he or she recommends for your specific case.Best regards,

William Portuese, MD · Answer

Nasal cartilage is always that primary choice for nasal reconstruction when performing a revision rhinoplasty. What is more important to know is whether or not there's any cartilage left on the inside of the nose after the primary rhinoplasty. In most cases, there is usually enough nasal cartilage left in the nose for spreader grafts tip grafts and bridge augmentation when there is a virgin septum present. Septal cartilage does not tend to warp.

Robert Whitfield, MD · Answer

For complicated revision surgery I have always closed rib cartilage.Ear cartilage is not the donor site I would choose for the surgery your are describing. In terms of warping I still would choose rib cartilage again as the best choice.

Pros and cons of ear and rib grafts?

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Pros and cons of ear and rib grafts?

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