Four previous rhinoplasties, very thin skin. Would rib cartilage be safe to use for dorsal height? Am I risking skin rupture?

Hi there! Excellent questions. A rib cartilage graft is ideal for augmenting the dorsum. I would advise against any foreign material such as Mersilene as it can be a nidus for infection long-term. For thin skin, I often add camouflage in the form of rib perichondrium or temporalis fascia. To further boost the effect, microfat can be added which provides stem cells and growth factors for healing. Thin skin can be challenging and making sure the skin envelope has good blood supply is critical to success before re-operating. I would seek consultation with another surgeon if you feel like you're not getting the result you'd hope for. Hope this helps!