Is dicing rib cartilage to prevent it from warping a common technique?

Hi Roze:Dicing rib cartilage and placing it in temporalis fascia as a "burrito" can be a good way to augment the bridge of the nose.  Even if solid rib grafts are prevented from warping, the edges can be visible in patients with thin skin.  I would agree with the other respondent that many different approaches using rib cartilage can be effective depending on the patient (ethnicity, skin thickness) and surgeon's experience with a particular technique.  I would ask your surgeon to show you his/her results if you are worried about his/her plan.  Best of luck. 

There are several techniques to prevent or reduce rib cartilage warping.  I use all three depending on the indication.1) dicing and placing in tpf2) threaded k wire in the core3) symmetric carving to the central coreall are common enough and effective, again depending on the situation.

Diced cartilage is a better alternative to rib cartilage as warping could happen with the latter. This procedure is relatively new but done by those who surgeons performing revision rhinoplasty.

The technique you describe is one of a number we use to add to a deficient area.  While it works well as a pure augmentation, it cannot do structural things like hold up other cartilages or improve the airway, which other augmentation techniques can do when required.  Having said that it is a great tool if only pure augmentation (addition) is required. As you say an additional advantage is that it doesn't warp. After some time it becomes relatively solid as the small pieces are bound together by scar tissue.It's a great technique when used in the right way and in the right context.

There is a difference between what theoretically works, and what actually does. The most important aspect of what actually works for a particular technique, is what works for the particular surgeon. Experience and individual results are more important in achieving a long term outcome than any specific technique.That being said, the cutting and dicing with Temporal Fascia does not yield as good results, in my experience,  as working with rib cartilage. Although there is a chance of warping, in experienced hands this can be minimized. Using the temporal fascia technique has its own inherit risks.Bottom line, is look for the right surgeon who can achieve what you are looking for, and has vast experience.Good luck,

Warping is one of the risks of using rib cartilage; I frequently use diced cartilage wrapped in fascia but over the past 35 years I've rarely needed to use rib cartilage. Dicing of any cartilage will minimize the problem of warping but will not provide the strength necessary for structural support.

Rib cartilage is needed for revision rhinoplasty in certain cases.  In my experience most revisions can be performed using ear cartilage (less scar, less pain).  Whatever cartilage is used can warp, so there are techniques for carving that take this into account.  Dicing and rolling in fascia is a good way to add volume but this does not give any additional support to the nose.  For revision rhinoplasty more support is usually needed.Be sure to consult a surgeon Certified by the American Board of Plastic Surgery.  Find one who has a lot of revision rhinoplasty experience and insist on seeing a comprehensive portfolio of pre- and post-op pictures so you can gauge your surgeon's experience level and expertise.

When wrapped in fascia, the implant isn't as rigid as the intact rib cartilage and not as much can be done with it.  A newer technique is making a block of diced cartilage with tissue glue.  Our experience and that in the literature would indicate that there is minimal warping and very good augmentation can be achieved.  Best wishes.