What is the risk of rib cartilage rhinoplasty?

There are risk associated with the harvesting of the ribs grafts, which include bleeding, infection, pain and pneumothorax. These risk are quite rare in the donor site but it is typically quite painful. After the grafts have been placed in the nose there is a chance of infection, absorption and warping. There are things that your surgeon can do to minimize these risk as well. There are few easy fixes in rhinoplasty so it really depends on how badly it warps but typically it requires a revision rhinoplasty. 

Rib cartilage for rhimoplasty is typically used for rhimoplasty revision or after trauma.  Taking a piece of rib requires a small incision and there is a small risk of entering the lung space.  Any kind of implant can shift or resort over time but rib grafts are pretty predictable when done by an experienced surgeon.

Thank you for your question. I suggest that you move forward and consult with your board certified facial plastic surgeon to discuss the risks that are specific to you, which we would not be aware of without understanding your health.
Best wishes,

It looks like you are undergoing major rhinoplasty? Rib cartilage grafts are used in situation where major changes in size and shape of nose is needed. In experienced hands it is good option for cartilage graft supply and without serious consequences. Depending of how cartilage grafts are used, for example as a block to increase height and length of the dorsum, this large graft may warp (curve) and in time change the shape of reconstructed nose. To avoid that, cartilage dicing into small particles or cutting into long strips, which are then placed into fascia wrap was recommended by many surgeons. This is a technique that we use in a case of a complex secondary nose reconstruction or correction of ethnic (Asian, African-American) nose. This technique doesn't seem to follow long term pattern of rib cartilage warping.

The use of a solid rib graft for rhinoplasty is associated with the risk of warping of the graft what you call 'shifting'. This problem can be overcome by using a diced cartilage technique which eliminates all risks of postoperative rib graft warping.

I have been performing numerous rib graft rhinoplasties (about 20-30 per year) and would love to share information on a topic that I am very passionate about. Primarily rib grafts are used in revision rhinoplasty cases. If there is a significant congenital or traumatic deformity of the nose it may be used in primary rhinoplasty.  I make the incision under the crease of the breast.  The size of the incision usually ranges from 1.5 to 4 cm based on the shape of the body (the skinnier you are the smaller the incision).  To give you an idea the average breast implant is placed through a 5 cm incision. The risks of rib cartilage harvest includes scar, bleeding, pain, numbness, lung injury / pneumothorax,  chest deformity. You will have soreness in your chest the night of the procedure. This pain is made worse by coughing, turning, laughing (try not to be around funny people :).  Most of my patients complain of little pain at one week and by two weeks they feel fine.  The scar is normally hidden under the breast and after one year is a faint line. I have harvested rib grafts in children all the way to patients in their 70s.  The ideal age for rib graft harvest is from late 20s to early 50s.   In younger patients the rib has less calcifications (harderning) . This softer rib is easier to sculpt,  however it is at higher risk for warping inside the nose.  In patients in their 50s, the rib can become very calcified (hard) and difficult to sculpt.  However this more calcified rib is less likely to warp. I check for warping of the rib during surgery and in very rare occasions I was not able to use the rib that I harvested for concern about warping. It is critical that you protect your nose after the surgery and do no allow any trauma to it! It is most heartbreaking and frustrating for the patient and surgeon to hear about patient falling onto their nose, walking into a glass door, or getting elbowed in sleep by spouse. Trauma to the nose will certainly alter the appearance.  I hope this information helps and I wish you the best on your surgery. Please make sure that your surgeon has significant experience in rib graft rhinoplasty and I highly recommend a board-certified facial plastic surgeon. Dr. Farhad Ardeshirpour

Two things you should know about rib graft rhinoplasty. First, for dorsal augmentation, we mince the cartilage into tiny particles that are used to make a burrito. this allows for avoidance of any warping, etc. Second, you should consider using cadaveric rib graft which avoids needing to harvest your own.

The risks of harvesting rib cartilage include bleeding, infection,scarring, and a pneumothorax. Let me play devil's advocate and tell you that over the years I have rarely needed to harvest rib cartilage unless the patient needed extensive nasal reconstruction.

Dear Jenisel29, If you are having a primary rhinoplasty I am unsure as to why you would need rib graft? Most surgeons prefer to use the nasal cartilage for grafting. Rib grafts have risks associated with the harvesting as well as that they are known to provide a painful recovery period. You may want to have a secondary opinion and you can be advised at that time of the risks and complications that can be associated with rib grafting. Best regards, Michael V. Elam, M.D.