Rhinoplasty adding rib graft to your upper nose bridge?

Question

When a surgeon adds rib graft to the top of your bridge. How is the rib graft fixed in place? Do they glue it down on to your bridge bone? Also how dose the graft go over time?

Scott Trimas, MD · Answer

Typically, the rib graft is placed as an onlay graft on top of your underlying bone and cartilage to raise up a depressed bridge. Over time, it does tend to fixate to the underlying tissues. That being said, rib grafts tend to always be a little firmer than your natural cartilage and bone in that area. Sometimes the rib can resorb over time but that likelihood is fairly small.

Manish H. Shah, MD, FACS · Answer

Hello,Thanks for your question. When rib graft is placed on the bridge, it can be fixated in a number of ways. It can be placed into a precise pocket with nothing but suture fixation. It can be placed in the pocket with K-wire transfixion. Rib graft has a tendency to warp even with correct cutting techniques used so some type of fixation is always helpful. If cadaver rib is used, the resorption rate over time is higher than with native rib cartilage. Work with a rhinoplasty surgeon who specializes in rib graft surgery for more information.Good luck,Dr. Shah

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  For rib grafts used in dorsal augmentation, many surgeons fix the rib into place using a k wire.  Depending on your nasal anatomy, instead of rib, I often used diced cartilage wrapped in facsia for dorsa augmentation.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Miguel Mascaro, MD · Answer

Great question.  It depends on what is needed as far as your dorsal augmentation.  Some docs will actually take the rib graft and dice it to create a softer cartilage augmentation with temporalis fascia.  Others will create a shell with the diced cartilage and fibrin glue.  Traditionally, after carefully shaping the implant, a very precise pocket is created just above the bone and cartilage of the nose where this is placed.  In some extreme, reconstructive cases (think trauma, etc) it may be fixated in place.  As you can see, there are various techniques, and not only is it surgeon dependent, but more importantly patient dependent.  Not everyone needs the same, and one way is not "better than the others all the time".  Your best bet is ask the doctor whom you saw in consultation how and why they are planning to do it.  Best of luck!

Barry L. Eppley, MD, DMD · Answer

The best approach to using a rib graft in the upper portion of the nose is a diced approach. The rapid ingrowth of tissue into the graft will create secure fixation and eliminate any risk of warping.

William Portuese, MD · Answer

The gold standard for building up the bridge of the nose is to use nasal cartilage as a primary source of grafting material. There are many issues with the use of rib grafting in the bridge of the nose. Both grafts are usually placed in a precise pocket along the bridge line of the nose to hold it in place

Anthony Bared, MD, FACS · Answer

Securing rib graft to the bridge is entirely dependent on the techniques of the surgeon.  It is very important that if rib graft is used to augment the bridge of the nose that the graft is properly secured to the bridge.  Various techniques can be employed including suturing and the creation of a tight pocket to decrease the possibility of graft mobility and visibility.

Richard W. Fleming, MD (retired) · Answer

When augmenting the nasal bridge I prefer the use of diced cartilage/fascia grafts regardless of the source of that cartilage. The fascia sleeve is secured using sutures.

Rhinoplasty adding rib graft to your upper nose bridge?

Answers (8)

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