Grafting Techniques for Nasal Valve Collapse - Would it be advisable to reuse rib cartilage harvested 10 years ago?

Many thanks for you enquiryIt is possible to reuse graft material but you may still have insufficient graft material as with the lateral crural tensioning technique, the alar cartilages (that help make up the shape of the nostrils) are repositioned onto a midline support at the nasal tip and also benefit from additional grafts placed to support the alar cartilages. This support can be taken from the septum but if you have had prior surgery, it is likely that there will be insufficient material and you would require grafts taken from elsewhere. Whilst ear cartilage can be used, I find that this does not have sufficient strength as a support structure and hence your own cartilage or donor cartilage would be better. Finally, we would generally tension both sides to help with symmetry and function. However, an alternative consideration which is much less invasive is an alar strut graft (that can be placed via incisions inside the nostrils) or a Latera implant. Best WishesPhilip Michael

Thanks Courageous511253 for your question! That's a really thoughtful set of questions, and it highlights the complexities involved in revision rhinoplasty. Rib graft may or may not be used depending onits viability and degree of strength and resiliency needed.
Regarding the advisability of reusing rib cartilage harvested 10 years ago, once cartilage is harvested and implanted, it becomes incorporated into the surrounding tissue through a process of healing and fibrosis. After 10 years, this graft is no longer "living" in the same way fresh cartilage is. It essentially acts as a structural support. While rib cartilage is generally known for its long-term stability, over a decade, there's a possibility of some degree of resorption or subtle changes in its shape. The fact that the existing graft is now visibly protruding into the nasal cavity on one side suggests a potential issue with its initial placement, migration, or possibly some degree of warping or extrusion over time. Reusing it in its current state, especially if the protrusion is contributing to the nasal valve collapse, would likely perpetuate the problem.
Considering these points, reusing the old rib cartilage is relatively spoken not advisable. Fresh cartilage offers better predictability in terms of shape, strength, and long-term integration.
Addressing the risk of performing lateral crural tensioning on only the affected side during an open rhinoplasty, it's generally recommended to address both sides, even if only one side is currently symptomatic, to optimize long-term symmetry and functional balance. The degree of intervention on the "unaffected" side can be tailored to maintain its current good function while ensuring overall symmetry with the treated side.
Given the need for potentially significant structural support to correct nasal valve collapse and perform lateral crural tensioning effectively, rib cartilage is the preferred source. It provides a larger quantity of stronger, more predictable cartilage that can be carved and shaped to provide durable support to the nasal framework.
In summary, the most advisable approach would likely involve:
Using fresh frozen rib cartilage or autologus one for the lateral crural tensioning and any other necessary structural grafts. Addressing both sides of the nose during the open rhinoplasty to ensure optimal long-term symmetry and functional balance, even if the intervention on the currently well-functioning side is more conservative.
It's crucial to have a thorough consultation with an experienced revision rhinoplasty surgeon who can carefully evaluate your specific anatomy, the existing graft, and your functional and aesthetic goals to develop a personalized surgical plan. They will be able to best assess the risks and benefits of different approaches and cartilage sources in your unique situation.
Hope this was helpful!
Best wishes,
Dr Ali Sajjadian

Recognizing the importance of exploring your treatment options thoughtfully is the first step toward achieving a successful revision—thank you for articulating your concerns so clearly.
I see three distinct questions in what you've shared, each important in its own right. Here's how I would approach them:
1. Can rib cartilage harvested 10 years ago be reused for lateral crural tensioning?Possibly, but this depends entirely on the condition of the existing graft. After 10 years, rib cartilage may have undergone changes such as calcification, warping, or resorption, which could compromise its reliability. These characteristics can only be evaluated during a direct examination. In some cases, it may be structurally sound; in others, replacement may be the safer and more effective route.
2. If more cartilage is needed, is ear cartilage appropriate despite a prior failed attempt—or should rib cartilage be preferred?If ear cartilage was previously used unsuccessfully—perhaps due to insufficient strength or limited availability—it may not be ideal for this particular function, especially for structural support like tensioning. If harvesting autologous rib cartilage again is not preferred, cadaveric cartilage (such as irradiated or fresh-frozen costal allograft) could be a valid alternative, assuming your surgeon is familiar with its handling and long-term behavior.
3. Is it risky to perform lateral crural tensioning on only one side, leaving the other untouched?While tempting to treat only the symptomatic side, it’s important to understand that nasal structures are deeply interconnected. Addressing just one side can sometimes lead to new imbalances in function or symmetry over time. Especially in revision rhinoplasty, a bilateral approach—when indicated—often offers better long-term predictability and stability.
I highly recommend consulting with a board-certified plastic surgeon experienced in revision rhinoplasty, who can assess your graft history, airway function, and structural needs to create the most appropriate surgical plan.
Wishing you clarity and confidence as you move forward.

Believe you are asking whether or not some of your crafts can be repurposed from one place to another. Sometimes that is indeed the case, and sometimes grafts can crack when we expose them during surgery. A viable piece of cartilage that is 10 years old, or older, will remain viable as long as it is not broken. The musculoskeletal tissue foundation in new jersey provides lovely sheets of cadaver rib cartilage that are extremely versatile and have an excellent track record of safety and permanent when used for revision rhinoplasty surgeries. I hope this helps! Sincerely, Dr Joseph

I would not reuse the rib cartilage. You can use the ear cartilage graft or a cadaver graft. This may be your best option since there is no donor site. However, it does cost more. Sometimes the cartilage graft is bridged over the septum to act as a spreader to hold the internal valve nasal valve open.

Best Wishes,

Gary Horndeski, M.D.

Hello and thank you for your question. I would recommend using new cartilage. If septal cartilage is present that is always my number one choice. In the absence of septal cartilage, I prefer to use MTF cartilage. With good surgical technique, you could likely have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Few years ago, a fresh frozen rib cartilage grafts from cadavers, became available on the market. We have used these for already five years and did not find much of the difference in comparison to autologous (patient own) rib cartilage. They served very good for any kind of nose revision surgery. You should discuss this option with your surgeon or seek a second opinion consult with somebody who is familiar with this technique. Good luck.