Major Risks of Revision Rhinoplasty Using Rib Cartilage?

Doctor Answers 23

Use of rib cartilage in revision rhinoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

There are three types of cartilage used in revision rhinoplasty. The first choice is always cartilage from the septum, as it is straight, firm cartilage which does not require harvesting from outside of the nose. In cases where septal cartilage has already been used during previous surgery, the next choices are ear and rib.

Ear cartilage can be excellent for certain smaller grafts but tends to be weaker than septal cartilage and may not be strong enough for reconstructing noses which require major support.

Rib cartilage can also safely and effectively be used in revision rhinoplasty. The cartilage can be autologous, which means that it comes from the patient, or irradiated, which is donated by an individual who is deceased. The harvest of rib cartilage is done through an inconspicuous 2-3 cm incision, which can be tucked under the right breast in women. The first risk related to harvesting this cartilage is injury to the underlying lung or tissue layer around the lung, called the pleura. This can result in air being introduced around the lung, what is known as a pneumothorax. This extremely uncommon complication can be managed by temporary placement of a chest tube for a few days following the procedure. Other risks related to rib cartilage include the grafts becoming visible under the skin, shifting of the grafts, and resorption, or dissolving of the grafts. This risk of resorption is thought to be greater when the cartilage is irradiated (cadaveric cartilage). In general, use of rib cartilage is extremely safe and for surgeons who specialize in revision rhinoplasty, the benefits of utilizing rib cartilage greatly outweigh these risks.

Bay Area Facial Plastic Surgeon
4.7 out of 5 stars 52 reviews

Rib cartilage for rhinoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Rib cartilage is a great option for revision rhinoplasties but for primary, or first time, rhinoplasties septal cartilage or ear cartilage are preferred.  There are 2 ways to obtain rib cartilage:

1.  Rib can be harvested from your own rib cage.  This is your own tissue but there are several downsides which include a scar, the risk of lung injury, and pain that may require a prolonged hospital stay.

2.  Irradiated rib can be obtained from a cartilage bank.  There are about a half dozen in the US and the cost depends on the supply.  These ribs are radiated so the chance of a contagious infection is almost non-existent.  This avoids the scar, the risk of lung injury, but most importantly, the pain and hospital stay. 

Rib cartilage, much like septal or ear cartilage, used to add height to the nose have similar side effects.  The main one is migration of the cartilage even if stitched in place.  If that happens, the surgeon may have to revisit the nose and reposition the graft.  

Mike Majmundar, MD
Atlanta Facial Plastic Surgeon
4.5 out of 5 stars 50 reviews

Rib Cartilage Grafting for Revision Rhinoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

In revision rhinoplasty, it is usually necessary to reconstruct and reshape the nasal framework using cartilage grafts. Because available septal cartilage has usually been removed during the first surgery, grafts must obtained from either another site - the ear or the rib.

Rib cartilage has many uses and advantages in revision rhinoplasty. It can be carved or shaped to the desired configuration. Its rigidity can provide support to a weakend nasal framewoek.

Drawbacks of Rib Cartilage Include:

  • Rendency to warp (curve). This can make the result unpredictable.
  • Nose may feel firm or inflexible.

Potential Risks of Rib Cartilage Harvest:

  • Bleeding
  • Scarring
  • Pain
  • Infection
  • Collapsed lung (pneumothorax)
  • Chest wall deformity

However, in experienced hands, rib cartilage allows successful results in revision rhinoplasty.

C. Spencer Cochran, MD
Dallas Facial Plastic Surgeon
4.7 out of 5 stars 149 reviews

Risks of revision rhinoplasty using rib (costal) cartilage

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The risks are generally low when performed by an experienced surgeon but they can include (and are not limited to):

infection, bleeding, hematoma, wound breakdown, hyperftrophic or keloid scar formation, contour irregularity, hemo/pneumothorax, graft resorption or warping, overcorrection, undercorrection, graft rotation/extrusion/exposure, inability to acheive a specific funtional and/or cosmetic result.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Major Risks of Revision Rhinoplasty Using Rib Cartilage?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Rib cartilage is often the last resort for most of us. The cartilage harvested from the septum is the best graft for most indications.  A rib graft is often used when there is need for support rather than volume, in the absence septum graft. Rib cartilage is not an ideal choice as the tip graft unless 1) the surface portion of the graft is used which softer, 2) the graft is made really thin or 3) it is used on patients with very thick skin since it has had tendency to thin the skin, which is the first hazard of the rib graft. Additionally, the rib cartage has a tendency to warp. We have developed many techniques to minimize the chance for warping. In some sites. like the tip the rib cartilage can be too stiff. For that reason my choice of tip graft is the ear cartilage or slightly softened septum cartilage.

Bahman Guyuron, MD
Cleveland Plastic Surgeon
4.7 out of 5 stars 23 reviews

Rib Cartilage Risks for Rhinoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The use of rib cartilage is one that should only be done by a surgeon highly experienced in its use. First of all, there is the risk of lung collapse during the harvest of the implant (assuming it is going to be your own and not a cadaver rib). Once placed, with healing if not secured properly the rib can migrate, leaving asymmetries and other cosmetic problems of the nose. Lastly, the rib can fail to secure, becoming a moveable piece under the nasal skin.

Jeffrey Epstein, MD, FACS
Miami Facial Plastic Surgeon
4.7 out of 5 stars 145 reviews

Risks of rib cartilage in revision rhinoplasty.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Using rib cartilage in revision rhinoplasty is generally a safe procedure, but like any procedure there are risks. The risk of rib cartilage include scarring at the donor site incision, pneumothorax, and increased time under anesthesia. The risk of using rib as a grafting material include resorption, warping and visibility of the rib graft. All these risks are minimal if performed by a surgeon familiar and comfortable with the procedure.

Best of luck,

Dr. Kaniff

Thomas E. Kaniff, MD, FACS
Sacramento Facial Plastic Surgeon
4.7 out of 5 stars 25 reviews

Risks of revision

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The risks are not very different from the risks of primary rhinoplasty. However, these same complications have a higher chance of occurring in a revision cases. Due to the scarring and prior work done, there is a higher chance of asymmetries, etc. However, in good hands, these risks can be still be very small and a significant improvement can be expected. 

Jeffrey Jumaily, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

Rib Cartilage Potential Risks

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

One of the major risks include potential collapsed lung, however this is quite infrequent.  It can also warp which is a big potential problem but there are ways to minimize both with care and expertise of a true rhinoplasty expert.  Be sure to find a board certified plastic surgeon or otolaryngologist for your revision rhinoplasty.

Rod J. Rohrich, MD
Dallas Plastic Surgeon

A variety of choices are available when cartilage grafts are required.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}


Your question is stated without specifying the problem, or the region of the nose that a graft is being considered. 

With that, a variety of choices exist as donor sites, Septal Cartilage, Conchal (Ear) Cartilage, and Rib Cartilage.  Depending on the specifics of the need and history of prior procedure(s) I may choose any one of these.  From experience of having used all of these choices in rhinoplasty procedures, each donor site has its own set of considerations, and benefits.

Best wishes,

Sergio P. Maggi, MD, FACS

Austin Plastic Surgery Center

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.