Does Ear and Rib Cartilage for Nasal Tip Rhinoplasty Warp or Get Reabsorbed over Time?

Nasal cartilage is always the best primary grafting material for any tip augmentation.  Ear cartilage is the secondary material and rib cartilage is used when there is no ear or nasal cartilage left.  Ear cartilage is stiff compared to nasal cartilage and makes the nose feel more firm than normal.  Rib cartilage is rigid and tends to make the nose feel very hard and woody.  Rib cartilage has a very bad tendency to warp but usually does not get resorbed.  Synthetic implants are only placed along the bridge and are compose of silastic.  Synthetic implants should never be used in the tip of the nose. 

Synthetic implants are very seductive and attractive since they are of perfect shape and come out of the box without the need for surgical harvest. Used in the tip area they will almost always become extruded or infected requiring removal. On the dorsum some may do well for many years and never have a problem. Others may shift or also extrude.

Septal and ear cartilage will not warp, resorb or be extruded and will survive. Rib cartilage has a small chance of warping which is minimized by carving and using the central component. Cartilage will also feel more natural in the nose.

The best alternatives for tip support and projection in rhinoplasty are septal cartilage and ear cartilage. Both are stable and will not reabsorb and resist warping. Rib cartilage is a third choice as it is more difficult to obtain, and may have more tendency to warp. Synthetic materials are good, however there are ever present risks of infection or exposure of the implant.
Best of luck,
peterejohnsonmd

Supporting the shape of the nose tip is critical for long term results.  Cartilage is the best option because it is live tissue and will remain strong if appropriately supported by surrounding non-scar tissue and with adequate blood flow. 


Ear cartilage is a great option because it is strong enough but not too thick and will integrate in the new tip quickly, with less chance for warping and volume loss.

Rib cartilage is another option when a strong supporting structure is needed and no or very little native tip cartilage is available.  It is difficult to stabilize, commonly warps or changes shape albeit mildly, and required a significant and visible donor site incision.


Cartilage is an optimal choice for tip reconstruction but it has to be handled with care and placed in a "bed" that is non-scarred and with excellent blood flow.  In this situation, long term results in reference to shape retention and tip support are excellent, and there are none of the problems of synthetic materials.

Yes it does and this is well documented in the literature and has been for many years, yet some choose to still use this material.  I have performed Rhinoplasty and revision Rhinoplasty for over 20 years and I won't use rib cartilage or bone nor will I use ear cartilage to build up the nasal bridge because all of it has a tendency to dissolve unevenly, IMHO.  I do use ear cartilage to the nasal tip and silastic (straight) implant to build up the nasal bridge.

Ear cartilage and septal cartilage have been the mainstay of rhinoplasty for decades.  They have a good chance of long-term survival.  However, the patient must be aware that the survival rate can vary widely patient to patient and might require a revision if too much cartilage is resorbed.  There are techniques that a rhinoplastic surgeon can perform to increase the chance for survival..  

Hi,

The best material to use for nasal tip projection is either septal or auricular cartilage. Either one will provide for adequate and permanent projection. Rib cartilage can also be used if there isn't enough septal or auricular cartilage. Synthetic material in the nasal tip is not a good idea due to high risk of infection or extrusion.

Best,

Dr.S.