Why some doctors don't recommend Irradiated Rib Cartilage in Rhinoplasty and Asian Rhinoplasty?

Question

There are many pros with irradiated rib cartilage such as: no donor site morbidity, ease of use, shorter operation time & healing time. Why most of the doctors I consulted with don't recommend using it for Asian Rhinoplasty? Since Asians are prone to keloid, don't know how I feel about Autologous Rib Grafts. Please recommend doctors who are experts in Asian Rhinoplasty with Irradiated Cartilage in LA area. I would love to research more before making a big decision like this. Thank you! :)

Charles S. Lee, MD, FACS · Answer

In most patients, rib is not needed for your rhinoplasty. Ear cartilage and septum is almost always sufficient. Your own rib is preferable to irradiated rib if you are cartilage deficient. Irradiated rib is sometimes necessary to use if the patient's own ribs are calcified (typically older patients).

Donald B. Yoo, MD, FACS · Answer

The main downside with irradiated rib cartilage is the fact that it is dead tissue and not living, viable cartilage as from your own rib.  This means that it will not become a living part of your nose, but rather will be placed by fibrotic tissue that will eventually resorb.  For permanent results, your own cartilage (autologous grafts) is superior to any homologous grafts.  I perform rib cartilage harvest through a 2 cm incision, which will heal as a thin line which will become unnoticeable in the vast majority of patients.

Toby Mayer, MD · Answer

Asian rhinoplasty and use of patients own cartilage vs. rib? For 35 years i have used the patients own septal and ear cartilage without a keloid and what I feel is less risky than using any type of rib.

Steve Laverson, MD, FACS · Answer

Irradiated rib cartilage for dorsal nasal augmentation is a nice choice that, as you suggest, prevents donor site morbidity.  I've seen these grafts last for many years, over a decade.  Irradiated rib may still warp after carving. Porous polyethylene grafts incorporate well, are carvable, integrate into host tissue, and in my practice, have replaced irradiated rib in most patients.  For doctors in your area with irradiated rib cartilage experience, consider calling the tissue bank for referral to ordering physicians.  I order from University of Texas, Southwestern, Dallas, TX.

Suzanne Kim Doud Galli, MD, PhD, FACS · Answer

Using an irradiated rib graft for nasal augmentation is not unheard of. However, not every surgeon has been trained in this technique and many surgeons may prefer other options for augmentation. It may be a matter of personal preference.

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

Thank you for your question and I try to use the patient's own cartilage (septal or ear) when possible but I have found irradiated rib cartilage to be an excellent substitute and it avoids additional scarringDr Corbin

Michael Elam, MD (retired) · Answer

Dear Caligirl24, Many surgeons like myself are not fans of using rib cartilage and prefer to use either septal cartilage or ear cartilage. This is often a matter of preference. Best regards, Michael V. Elam, M.D.

David Alessi, MD - Account Suspended · Answer

I give the patient the option.  The resorption rate is slightly higher than with your own rib, but studies show it is mainly when it is a support issue and not volume issue.  Therefore, for augmentation of the bridge, irradiated rib is fine.  For Asian rhinoplasty, there needs to be substantial cartilage added and rib is typically the best.  For less significant augmentation, intra nasal and ear cartilage can be used.  Seek an opinion from a board-certified Facial Plastic surgeon.  Best wishes.

Richard W. Fleming, MD (retired) · Answer

I have not recommended the use of irradiated cartilage to augment the nose because various studies have shown that their is a higher degree of cartilage resorption. The procedure may be easier but I don't want a short term result. I have found that rib cartilage is rarely needed; I prefer to harvest cartilage from  the septum to the ears.

Why some doctors don't recommend Irradiated Rib Cartilage in Rhinoplasty and Asian Rhinoplasty?

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