Is ear cartilage adequate for typical Asian Rhinoplasty patient?

In the typical Asian rhinoplasty patient, is there enough ear cartilage to augment the bridge AND to increase projection and length of the nose? Are there any particular advantages to using rib cartilage vs. ear cartilage?

Doctor Answers 14

Rib vs. ear cartilage for augmentation during Asian rhinoplasty

The source of cartilage is dependent on the degree of augmentation and projection you are trying to achieve.  A significant change can be created using cartilage from your septum and your ears; however, to achieve maximum augmentation and refinement, rib cartilage is necessary.

The reason rib cartilage provides a greater degree of refinement is because it provides more structure since it is stronger.  Greater augmentation (or building of the bridge) is also possible because there is more cartilage available from the rib.  In addition, for projecting, lengthening, or counter-rotating the tip of the nose, rib cartilage grafts are often necessary to provide long-lasting results.  

As you can imagine, ear cartilage is softer and there is not as much of it available.  For mild to moderate augmentation, ear cartilage in combination with septal cartilage (cartilage from inside your nose) will suffice, but for more dramatic augmentation rib cartilage is necessary. 

Some rhinoplasty surgeons prefer ear cartilage due to their discomfort in harvesting rib cartilage in a minimally invasive way, and so will recommend only ear cartilage.  Consulting with an Asian rhinoplasty specialist who does a high volume of Asian rhinoplasties using ear and rib cartilage will give you the best option regarding your exact nose.     

Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 57 reviews

Ear cartilage grafting in Asian rhinoplasty

ear cartilage grafts can be adequate but it really depends.  If there is very little cartilage present in the nose the ears alone may not be enough especially if a significant change is desired.  It is very often the case and the Southeast Asian nose that both ears are required.  Many cases like this have very little septal cartilage to offer so this is not always a viable site to take a cartilage graft.  Rib grafting and silicone implants are other options as well.  Seek consultations with board-certified facial plastic surgeons who operate on the Asian nose frequently.  They should have several before-and-after photos showing there work and the specific techniques used in each case because no one set of techniques can be applied to every nose.

Chase Lay, MD
Double board-certified facial plastic surgeon
Asian facial plastics specialist

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 75 reviews

Asian Rhinoplasty and ear cartilage

I believe that ear cartilage is adequate for 97% or primary Asian rhinoplasty patients.  If the septum is inadequate, then ear cartilage will do the job.  However, in a rare number of Asian Rhinoplasty patients, the rib cartilage may be required. 

Jay Calvert, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 50 reviews

Ear cartilage in rhinoplasty

Ear cartilage is good to reconstruct the nasal tip, but usually doesn't have enough volume for bridge augmentation.  It is difficult to augment the Asian nose and get a nice result.  You may get best off avoiding the operation altogether, but impossible to tell without photos.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

Increasing the nasal bridge

You may not need to even have ear cartilage. I suggest starting with dermal filler injection only to see how you like it. Then, you could go with a silicone implant.

Edward J. Domanskis, MD
Newport Beach Plastic Surgeon
4.4 out of 5 stars 27 reviews

Ear cartilage for Asian rhinoplasty

Nasal cartilage is always preferable to ear cartilage for augmentation rhinoplasty in the Asian nose. If you have a cartilage depleted nose, then consideration for ear cartilage can be entertained. Rib cartilages and Silastic dorsal implants are other alternatives that can be considered, each with their own advantages and disadvantages.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Cartilage sources for Asian Rhinoplasty

Typically, using septum and ear cartilage is adequate for bridge augmentation and tip lengthening. A lot depends on how much tip projection or bridge height increase is needed.

With more extensive changes greater amount of cartilage would be needed.

Another consideration besides the amount of cartilage available is the quality/strength of cartilage available for rhinoplasty. Ear cartilage isn't usually strong enough to create septal extension grafts to provide significant nasal lengthening. Septum cartilage is often strong enough though that's not always the case and there may be inadequate amounts of cartilage available for use.

Rib cartilage (either from yourself or from a tissue bank) is another potential cartilage source. This would provide a large enough volume of strong cartilage if needed.

You can read more about Asian rhinoplasty and see before and after photos at my web reference link below.  

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 21 reviews

Asian Rhinoplasty and ear cartilage graft

Thanks for your question.
It is best to consult with a plastic surgeon who has a lot of experience with Asian rhinoplasty.
I routinely use a combination of cartilage from inside the nose and the ear cartilage to create better shape.
Typically, these graft may be used with fascia to create natural looking result with improvement in the dorsum and tip area. 
Best wishes,
Dr. Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 195 reviews

Rhinoplasty and dorsal augmentation

In the majority of my patients with a low dorsum, they often need more cartilage than what is available from the septum or the ear. Rib cartilage or other sources such as irradiated cartilage are often better.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Typical Asian rhinoplasty patient

The typical Asian rhinoplasty patient will need only ear cartilage and septal cartilage to augment the nose and refine the tip. This, however, depends on the degree of increase that is needed for the bridge of the nose and the radix. If the radix is very low or nonexistent then augmentation will require a good deal of cartilage. I always dice the cartilage and wrap it in deep temporalis fascia. It is the most natural approach. However, the diced cartilage can also be injected without the use of a fascia wrap.

Advantages of using rib cartilage: 
1) No septal cartilage or ear cartilage needs to be harvested. Rib cartilage can be used for the tip graft, septal extension graft (and any additional grafts) and building up the bridge of the nose and radix.
2) The rib cartilage can be cut into a very straight piece for use as the septal extension graft. If there is a crooked septum you will not have a good straight piece for this procedure.
* Rib cartilage is fairly quick and easy to harvest and most of my patients go home the same day and return to light activity in one week. 

Advantages of using ear cartilage:
- Avoid incision and scar on the chest
* A disadvantage is the harvested piece usually has a curve to it. I would only use it to dice and place in harvested fascia for use on the bridge of the nose. It is not ideal if a septal extension graft or tip graft is needed. 

I would recommend a consultation with a rhinoplasty surgeon who has experience in Asian rhinoplasty using either rib cartilage or ear cartilage. He or she will be able to give you more information on the degree of augmentation required and the type of cartilage recommended for the procedure.

Kristina Tansavatdi, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 33 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.