Rhinoplasty after septoplasty turbinate reduction surgery - is a rib cartilage graft necessary?

Question

Hi I did a consultation for rhinoplasty. I really want to get this done , but I'm a little on the fence considering that the surgeon I consulted with told me he may have to harvest cartilage from my rib considering that I had a septoplasty turbinate reduction surgery a few years ago. My question is this necessary and is this the only way to obtain a rhinoplasty, I not comfortable with this and would like to know what are my options. your response is appreciated.

Marc Polacco, MD · Answer

Thank you for your question. This is a concern that comes up often. Rib cartilage, either from you or a cadaver, is sometimes used in rhinoplasty to give more strength and support to the nose. This is most often the case in revisions if the septum and supporting cartilage of the nose have been weakened. Unfortunately, it's difficult to tell with absolute certainty if rib will be needed until we see and can test the cartilage during surgery. Fortunately, harvesting rib cartilage is fairly straightforward, and usually only a small piece is needed. The best option may be to seek consultation with a few other surgeons and hear their assessments. I hope this helps, and all the best.
-Dr. P

Selcuk Inanli, MD · Answer

Hello! Thank you for your question. As far as I can understand from your question this is going to be your second nose surgery. That is why your surgeon might need a extra cartilage from your rib. Your nose anatomy is changed fully and your surgeon cannot sure what is in it. He needs to cartilage for reshape your nose. Best Regards!

Nima Shemirani, MD · Answer

Hi there! This is an excellent question. Rib harvesting is sometimes necessary in revisions if the septum and supporting cartilage of the nose have been weakened. This will give more strength and support to the nose. Rib harvesting is fairly straightforward and commonly used in revision procedures. Best of luck to you!

Mark K. Markarian, MD, MSPH, FACS · Answer

Hello and thank you for your question.  I do agree that an alternate source for cartilage is necessary once you've had a septoplasty and your septal cartilage can no longer be harvested.  However, I would much rather utilize a donor/cadaver cartilage graft instead of making an incision along your chest to harvest rib cartilage with a subsequent risk of injury to your lung.  I commonly utilize MTF (Musculoskeletal Transplant Foundation) cartilage for all my revision rhinoplasties and/or primary rhinoplasties in patients who have undergone a prior septoplasty.  
  
The next step for you is to find the right aesthetic plastic surgeon.  In your rhinoplasty consultation, be sure your surgeon addresses all your aesthetic goals and concerns specifically, and discusses the surgery details including the position and size of the incisions used (with actual photographs and not just digital animations), the risks and benefits of the procedure, recovery time, and post-operative course.  Also, be sure to see plenty of before-and-after pictures in women who have a similar nose appearance to yours, and preferably at different time frames (3 weeks out, 3 months out, etc) to more accurately predict your own surgical outcome.

After seeking out a board-certified plastic surgeon who specializes in aesthetic plastic surgery, I think the most important component of the consultation is to establish a good connection with your plastic surgeon.  It’s the connection that allows you to clearly define your desired nose outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you.

For more information on rhinoplasty, please refer to my link below.

Good luck.

Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Aesthetic Plastic Surgeon

David Parizh, DO · Answer

If you need to restructure, add support and reconstruct the internal anatomy which serves as a foundation for the skin envelope then the surgeon would need building blocks. A good source is septum. Considering you do not have that alternate sources include ear and cadaveric cartilage. Everyone has their own style and recipe. The key is to structure a plan that meets your needs and goals!

Lucian Ion, FRCS · Answer

Thank you for your question.

Septoplasty means different things to different surgeons and the most important element is if cartilage from the nasal septum has been removed. In general, although after septoplasty, it is unlikely that the septum is suitable for cartilage graft harvest.

In addition to the option of using your own costal cartilage, it is possible to donor cartridge. Ear cartilage has also been used in rhinoplasty but a good number of surgeons are not confident that it provides adequate support. (I am one of them).

In my opinion, the most important part of the decision is whether you feel comfortable with the surgeon to provide the outcome that you seek rather than to decide about your treatment based on the projected method to be used.

Joshua D. Rosenberg, MD · Answer

Your surgeon will likely check if there is enough cartilage left in your septum. The classic septoplasty typically removes most of the septal cartilage that could be used as grafts during rhinoplasty. But, this is not always the case. If sufficient septal cartilage remains, my assumption is this would be your surgeon’s first choice. 
If there is not enough septal cartilage, ear or rib cartilage is typically the second choice. Ear cartilage has limited utility and rib cartilage is really the best secondary option. Finally, some surgeons use cadaveric rib cartilage. The plus side is that there is no rib donor site (at least for you). The downside is that it has some characteristics that make slightly inferior to your own rib cartilage. It’s also not always available. 
Good luck. Do keep in mind that the rib donor site is fairly minor. If you go forward with surgery, I’ll be you will love your new nose way more than you care about the donor site.

Jeffrey Lisiecki, MD · Answer

For a revision rhinoplasty where you have already had a septoplasty, additional cartilage graft will almost always be necessary, since there probably isn't enough septal cartilage left to use this (it was probably removed during the septoplasty). That being said, you don't need rib cartilage harvested from you. There is now fresh frozen rib cartilage graft from donors which can be brought into the OR and used in a revision rhinoplasty. This spares you the pain, extra incision, etc associated with rib cartilage harvest.
As an aside, ear cartilage does not typically work well for revision rhinoplasties--it is usually not strong enough for most of the things you would need a graft for!

Philip S. Schoenfeld, MD, FACS · Answer

It would be difficult to comment on the amount of cartilage that you would need for your rhinoplasty without actually examining your nose.  I think that your surgeon is preparing you appropriately for the fact that alternative sources of cartilage may be necessary if the septal cartilage has all been harvested during your prior septoplasty.  It is possible that there is still sufficient cartilage to perform your rhinoplasty.  I have used cadaveric rib grafts with significant success for over a decade.  The preparation and preservation of these grafts is different than it was many years ago and the grafts behave equivalently to your own rib graft without the need for harvesting.  You may want to inquire about this alternative.  Ear cartilage is likely not going to be an option if structural support is necessary.

Celal Alioglu, MD · Answer

Hello first of all I need to see your photos but also we can use your cartilage in your nose if it wil be enough

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