When is cartilage needed after primary rhinoplasty?

Question

Curious when cartilage is needed for a primary caucasian rhinoplasty? Rib cartilage is most commonly used from what i’ve read so far. But I mostly want deprojection and a smaller nose, also slope and smaller top. I feel like a doc would have to remove cartilage if anything, not add cartilage.

Anil R. Shah, MD · Answer

Hello,

When you are deprojecting the nose you don't need rib cartilage you should be able to use the nose in the nose which is called septo cartilage and that should be enough cartilage to do everything you need. If the surgeon wants to use extensive grafting they may want to use rib cartilage but that is not usually the case in most primary's.

Jigar Sitapara, MD · Answer

Good afternoon from Maryland!

In the vast majority of cases, no additional cartilage source other than your own nasal septum would be needed for a surgery that you describe. Certain ethnicities and nose types do not have nasal septal cartilage (you can't take the whole thing otherwise the nose would collapse) or their goal is to build up the flat, ill-defined bridge. These are the people that may require rib cartilage in a primary rhinoplasty and I doubt you would fall into one of those categories.

I hope that helps! As always, an in-person consultation will help you find the best surgeon for you.

Wishing you all the best!
Dr. Sitapara
Prime Facial Plastic Surgery

Anya Costeloe, DO · Answer

Hi! Thanks for your question. I frequently use septal cartilage for grafts during primary rhinoplasty. Even when I am making the nose smaller, I used cartilage grafts to provide support and definition. Some specific uses for cartilage are to build up a flat nasal bridge, to straighten a crooked nose, to improve nasal function by providing support to the nasal valve and to refine the nasal tip. 
Rib cartilage is rarely needed for a primary rhinoplasty. It may be needed if the septal cartilage is small and weak and in the specific situations where more support is needed. I recommend scheduling a consultation with a facial plastic surgeon. Best of luck!

Andrew Miller, MD · Answer

It does sound like your nose does not need to be augmented. Sometimes, the tip needs additional support, especially if you are making it smaller. So the septal cartilage is mostly used for that. It's rare that rib cartilage would be needed in primarily rhinoplasty unless the nose is very flat and skin is very thick. Otherwise, rib is usually used in revision cases. Be sure to see a rhinoplasty specialist for consultation.

Jeffrey S. Rosenthal, MD · Answer

A Rhinoplasty is sculpting of the underlying delicate cartilage and bone irregularities.  Only if there is a depression of significant defect is additional cartilage required.  This is usually obtained from the nose septum

Guray Yesiladali, MD, FEBOPRAS · Answer

Cartilage grafts in rhinoplasty can be used to reshape and support the nasal structure. However, whether cartilage is needed for primary rhinoplasty depends on the patient's specific needs and desires. Generally, procedures such as nasal deprojection and tip reduction involve the removal of cartilage. However, additional cartilage may be required to reshape the nasal structure and ensure long-term stability. In these cases, cartilage is typically taken from the ear or nasal septum. Rib cartilage is preferred when larger amounts of cartilage are needed. If the goal is nasal reduction and profile correction, these procedures usually involve cartilage removal. However, the surgeon's assessment and detailed examination during surgical planning will determine th tip or providing support to the nasal bridge. If the goal is nasal reduction and profile correction, these procedures usually involve cartilage removal. However, the surgeon's assessment and detailed examination during surgical planning will determine the most appropriate approach.

Lucian Ion, FRCS · Answer

Thank you for your question. You raise a very valid point. In general, the tip cartilages are relatively soft and are not very reliable for controlling the shape of the nasal tip through rhinoplasty because they tend to twist or displace. Even a reduction rhinoplasty requires control and good support, similar to how a small house requires support, not just a building with several levels.

When pressing the tip of the nose up, you can get a sense of how strong the support from the nasal septum is. If there is approximately one centimeter of displacement of the underside of the tip before you feel firm support from the septum, the gap that needs to be covered by cartilage support is significant. This suggests that it may not be possible to obtain a significant amount of cartilage from the nasal septum.

This would be a typical scenario where a Caucasian primary reduction rhinoplasty might require rib cartilage to complement the structural support. Additionally, a history of injury or surgery on the nasal septum could make the septum an unreliable source for cartilage grafts.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.
As far as I can understand from your question, if you have had a previous nose operation, it may be necessary to use extra cartilage from the rib or ear. Or, depending on the structure of the nose, it may sometimes be necessary to use cartilage in the first nose operations.
It would be better face to face to consultation.
Best Regards!

Zeshaan Maan, MD · Answer

Rib cartilage is typically only necessary in primary rhinoplasty when significant augmentation is needed. This is generally not the case in Caucasian patients. Any cartilage that might be needed in a typical "reduction" rhinoplasty (for various grafts) can normally be obtained from the nasal septum, avoiding the need for a separate donor site, and providing superior cartilage for the purposes of a rhinoplasty.

Eric M. Joseph, MD · Answer

Even when we perform primary nasal reduction surgery, we utilize cartilage graft to support somebody's nasal tip so that it shouldn't droop or change with aging. The most common graph that we use in just about everybody is a columella shoring strut graft which is about the size of a matchstick. We typically harvest this from somebody's nasal septum, not the rib. Thank you for your question! Sincerely, Dr. Joseph

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