Would rib harvest be safe for my condition? Is fresh frozen better? (photo)

Question

I had sinus surgery where the surgeon also tried to correct a hump and deviation, but it failed. I still have some breathing issues, a larger hump, open roof, and deviation. I have thin skin on top and darkened skin above the hump. The tip was untouched, but cartilage may have been taken from the right side under tip (not sure). Went to many surgeons and they said my nose is strong and may still have cartilage but they need my own rib in case for support. Some said ear cartilage is enough but I am not sure about that. However, due to chronic health problems including endometriosis (cyst that will need surgery soon), asthma, osteomalacia, scoliosis, low muscle mass being underweight, I fear the procedure of harvesting the rib might be brutal for me. I cannot fly to the another country now but if the fresh frozen is a better option I might save for it for a few years. I am 37 years old female. Any help would be appreciated. Thank you!

Alejandro Nogueira, MD · Answer

Be wary of rib cartilage proposals, your case does not seem to me in such massive need of new parts as for harvesting your own rib (that'd not be brutal for you, just an unnecessary scar, pain and financial extra cost). Do not accept cadaver rib marterial, it is beyond be this trendy fashion in the US, it is not real cartilage cells, the chondrocytes are killed by the irradiation, so it is only the substance, hence poor outcomes, resorbtion, etc.

Yes, you are right to say the profile has been very badly worked on, you were left with an undercorrected middle vault, the tip is collapsing and shortened+upturned, the nostril rims are massively retracted, no tip definition, etc, plus the open roof you rightly mentioned.

Find a surgeon who does not fly around with exotic or ultracomplex techniques, finds your case routinary and has done hundreds like yours; only ear cartilage and septal (if it remains) should suffice; note: the extra cartilage surplus at the middle vault can be and has to be re-used as grafting too!

Eric M. Joseph, MD · Answer

MTF ( Musculoskeletal Tissue Foundation) makes "Profile sheets" of cadaver rib cartilage that has been an excellent alternative to autologous rib or autologous ear cartilage for grafting purposes in rhinoplasty. Depending on your examination, this may be completely unnecessary, if your previous surgeon left an adequate strip of cartilage in your nasal septum. Consider getting a second opinion. Thank you so much for this question. Sincerely, Dr Joseph

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, a well designed rhinoplasty would likely have a nice result. If you still have septal cartilage left, then I would use that. If septum is absent then I would use MTF cartilage. With good surgical technique, you could 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

Best wishes and good luck.

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

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