Does ear cartilage last a lifetime in revision rhinoplasty surgery? Why would one surgeon say rib while another does not? (photo

Question

I have thin skin and need tip work and also my internal valves are collapsing, my breathing is really bad on my right side. We have no idea if i have septal cartilage until surgery. I don't mind using rib but what if the surgeon I like didn't recommend it?

Jonathan Kulbersh, MD · Answer

Thank you for your question and I appreciate your concern. I assure you that both ear and rib cartilage can be used successfully to produce lifetime results. The choice of cartilage often depends on the personal preference of the surgeon and a variety of factors involving the patient. One is not necessarily better than the other. More important is the experience and expertise of the surgeon that performs your procedure. If you have found a qualified surgeon that you like, your procedure should be both safe and successful.

Steven M. Denenberg, MD · Answer

From these photos, and ones you posted previously, it seems that the main features of your nose to change are the width of the tip and the low position of the tip: the length of the nose.I don't have three-quarter or profile views, though, and those views are very important in a nose where the bottom of the tip seems to droop, like yours does on the first photo here. Those other views often make the nose look even longer than the frontal view, and can be used to make good morphs, so you can set a good ideal goal for the operation. Rib is almost never needed to elevate and narrow the tip. In fact elevating the tip is one of the more predictable changes to make, even in a revision.
The woman in the short video that I posted with this answer had the tip of her nose elevated and narrowed a significant amount in her revision operation.
I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should always be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and only the surgeon has that information and judgment.)
Remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, requiring skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.
Your nose is also a perfect example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?

Toby Mayer, MD · Answer

I have done thousands of noses in 44 years of revision rhinoplasty and rarely used rib except for extreme trauma. LYOUR ear and septum should have enough cartilage which does last forever. See below

Tarek V. Copty, MD, FACS · Answer

The source and type of cartilage depends on several aspects. How much is needed, thickness of skin, number of previous surgeries, age of the patient and most importantly is the surgeon's preference and experience. My personal preference is septal cartilage and then rib cartilage. Make sure your plastic surgeon is experienced with revision rhinoplasty, it requires thousands of noses to become an expert. Best regards, 
Tarek V. Copty, MD FACS 
American Board of Surgery American Board of Cosmetic Surgery Jordanian Board of Plastic & Reconstructive Surgery Fellow, American College of SurgeonsFellow, American Academy of Cosmetic Surgery

William Portuese, MD · Answer

Nasal cartilage  is always the  best source for grafting purposes when performing a revision rhinoplasty.  If there is no cartilage  inside the nose from a previous previous septoplasty, then ear cartilage is used.  Also depends upon what type of cartilage grafts may or may not be necessary with a revision rhinoplasty procedure.

Richard W. Fleming, MD (retired) · Answer

I have successfully used ear cartilage grafts in revision rhinoplasty for many years; by success I mean the graft lasts a lifetime. My first choice for graft material is the septum which is the easiest to harvest because I'm already operating on the nose. Very, very rarely is it necessary to take rib cartilage which is more difficult for both the patient and surgeon.

Does ear cartilage last a lifetime in revision rhinoplasty surgery? Why would one surgeon say rib while another does not? (photo

Answers (6)

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