Counter-rotation and projection of the tip during revision rhinoplasty
Picture quality aside, your nose appears over-rotated (turned up) and under-projected (too close to your face). In order to counter-rotate (turn down) and project (make taller) your tip, ear cartilage is going to be too soft and probably inadequate in quantity to achieve that. If I had to make a recommendation based on the single view photo above, rib is the superior option for your revision. Cost will depend on the surgeon.
Cartilage for Revision Rhinoplasty
The cartilage that is best for revision rhinoplasty is really determined by what needs to be done, and what cartilage is available in the nose itself.
My preferred choice for areas that require straight flat pieces of cartilage is the septum. If you have any septal cartilage left after your primary procedure it can be ideal for repair of deviations in the bridge, lengthening the tip, or de-rotating an over-rotated (up-turned) nose.
If there is not enough left in the septum, the rib is the next best choice for straight and flat segments of cartilage. It is also a very strong cartilage, and readily available.
Ear cartilage, which is generally curved, can be used effectively for repair of. tip deformities, and occasionally for repair of a curved or deviated bridge. There are also ways of using this cartilage for augmentation of the dorsum by dicing the cartilage into small 1mm cubes that can be inserted into a roll of temporal fascia (covering of the muscle in the temporal area). This procedure can be excellent in replacing cartilage in the bridge after over-reduction in a previous rhinoplasty.
In summary, the choice really depends on what you need, and what you have left in the septum.
The cost of revision rhinoplasty varies by geographic location, and what needs to be done to get your desired outcome, so it would be best for you to see a few revision rhinoplasty specialists in the UK for consultation to see what this would cost you.
Cartilage choices for Revision Rhinoplasty
If there is adequate cartilage left from the septum, this would be the usual preferred material. For lengthening a nose that's been too reduced (which the photo seems to suggest), a cap graft of ear cartilage is possible, but its inherent curvatures and elastic properties tend to be less than ideal for more significant revisions. For those cases, rib is very good, either harvested from the patient or as irradiated rib from a cadaver source. Care must be taken in either case not to try to overdo what the rib is capable of, though.
All the best,
Nasal cartilage for revision rhinoplasty
Nasal cartilage is always the best substance for grafting purposes for revision rhinoplasty. If the nose has been depleted of cartilage from a previous septoplasty, then your ear cartilage is the next best step. If the ear cartilage is not sufficient, then consideration for rib cartilage or synthetic material
Revision Rhinoplasty Graft Materials
Thank you for the question and your picture. It seems like your nose is turned up a bit too much. There may be other issues, but it is difficult to tell from the picture. Generally speaking, revision rhinoplasty requires more grafts made of stronger cartilage. If there is septal cartilage available, this is ideal. It has less issues with warping and resorption than rib cartilage. If not enough septal cartilage is present, then rib is the next best option. Ear cartilage is appropriate for some types of graft, but in general lacks the strength of other sources.
Wow, this is a tough photo to see your nose thoroughly. The nasal tip appears over-rotated but I can't sort anything else about the size and or shape and would need better photos of the base, side and front of the nose to make further recommendations.
Rib cartilage for thick skin
The reality is that the best cartilage for a rhinoplasty revision depends on the nose and the problem that is trying to be addressed. Thick skin calls for stronger cartilage so I like rib in these cases, but septum is always great if it is there.
You need to communicate with your surgeon so that both you and the surgeon understand what you want. Secondary rhinoplasty is more difficult than primary rhinoplasty.
As for the cartilage graft source will depend on what is needed to be done.
The nasal septum is the best and easiest source if it was not worked on or removed, it can be used for the dorsum, the tip or both.
Ear cartilage is used for tip work mainly.
Rib cartilage grafts are used to build the dorsum of the nose up, in very low and collpsed noses, or to lengthen the nose.
Obtaining the graft from the septum is cheeper than obtaining the rib cartilage graft.
The cost can be from $10k - 12k total cost.
Cartilage for Revision Rhinoplasty depends on what you need
I agree with some of the previous doctors.
Septal cartilage is usually sufficient for revision...the key is you need to have some left.
In your particular case if you do not have enough cartilage in your nose it would seem that rib cartilage would be your best choice to turn your nose back down.
Cost varies greatly...but more important is experience. Meet with several doctors and make sure you see photos of noses (like yours) and the results these doctors can achieve.
Cartilage graft and donor site options for revision rhinoplasty (nose job)
The best type of cartilage for a rhinoplasty is septal cartilage if you have enough. If this is inadequate, then you should consider ear carilage for the tip and rib cartilage for the nasal bridge.