Cadaveric rib (not my own) or silicone?

Question

For asian, is it better to go with cadaveric rib that isn't my own or silicone? What's the advantage and disadvantage? I have hard time to decide. Please advise.

Charles S. Lee, MD, FACS · Answer

If you have not had prior rhinoplasty, you can almost always use your own tissues (ear cartilage and septum) and avoid an implant or cadaver rib. Silicone implants, if they are to be used, are best for the bridge, but there is always enough ear cartilage to build the bridge (we dice and wrap this in scalp tissue (fascia) and rolled into a "burrito" to place along the bridge). The tip area, which is where you might use cadaver cartilage, can usually (85% of time) be reconstructed using your internal nasal tissues (septum). In the group that needs more tissue than available, I would strongly recommend using your own rib cartilage. You can avoid the unpredictable resorption rates associated with cadaver cartilage.

Alejandro Nogueira, MD · Answer

Beware! asian rhinoplasties, specially those from Filipino / Malaysian / Indonesian origin are probably the most difficult ones in ethnic cases; they need massive grafting and many surgeons take a shortcut through the easy ride... and turn to the cadaveric rib or the worst: alloplastic (silicone or goretex) prosthesis. Do not admit such procedures, refuse right away and seek the opinion of a good and experienced surgeon with skills, patience, creativity and knowledge how to harvest, mount, tailor and assemble grafting for the noses, and particularly experienced in asian noses.
Alloplastic prosthesis in noses are, sooner or later, total disasters... leading always to poor or bad early results; do research well. Cadaveric are troublesome, resorb, and are not yours!
Images are required to provide overal assessment of your nose.
Feel free to request any additional information from me.

Donald B. Yoo, MD, FACS · Answer

The absolute safest material for your nose from a lifelong, permanent perspective is tissue from your own body (autologous grafts).  Autologous graft techniques do require specialized expertise, and you will achieve the best results with a rhinoplasty specialist experienced in rib cartilage and ear cartilage grafting techniques.

Michael J. Yoo, MD · Answer

There is no question that autologous or your own rib is far superior to silicone in asian rhinoplasty when performed by an experienced rhinoplasty surgeon.  Silicone has a tendency to create problems with time - thinning of the skin, contracture etc.
Best to consult with a Board Certified Plastic Surgeon in your area.

Victor Chung, MD · Answer

Rhinoplasty is a surgery to improve the shape of the nose for breathing or appearance. In Asian rhinoplasty, many patients want to raise the bridge. This requires an augmentation graft. Although there are many patients with silicone implants, they carry a lifetime risk of infection or extrusion (breaking through the skin). I prefer using a patient's own cartilage over cadaveric cartilage. Only living tissue can truly integrate into your nose. Carving rib cartilage is an advanced technique, so I would seek out a surgeon who is familiar with harvesting and carving for a safe and happy result. Safety comes first.

Chase Lay, MD · Answer

It depends on what area of the nose but I've used cadaveric cartilage for the bridge with pretty nice results.  I feel it looks a little more natural than the silicon in a thin skinned patient.  However, I do sometimes like silicon for the bridge in male patients with thicker skin.  I DON'T use either of those for the tip or columella.  When you can, use your own cartilage.Chase Lay, MD

Arian Mowlavi, MD, FACS (license on probation) · Answer

You should definitely go with a cadaveric rib graft as it becomes assimilated with your nose; this is in contrast to silicone implant which will never get assimilated and will inevitably become infected and extruded.

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the question and cartilage, your own or from a cadaver is a better choice then silicone as there is less risk of exposure and infectionDr Corbin

David Alessi, MD - Account Suspended · Answer

Rib is a better choice overall.  With silicone, we worry about extrusion.  Having said that, I have never seen silicone implant extrude in a thick skin male patient.  I have seen it several times in a female.  Overall, unless there is some reason that you can't use rib, stick with rib.  Best wishes.

Cadaveric rib (not my own) or silicone?

Answers (9)

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