Major Risks of Revision Rhinoplasty Using Rib Cartilage?

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.

Assuming there are no donor site complications from harvesting the rib, the biggest risks in using rib cartilage in rhinoplasties are warping and resorption of the cartilage. This complication is very frustrating for both the patient and the surgeon. A nose that looks almost perfect initially can twist and get reabsorbed years later. Synthetic implants have there own unique set of risks and potential complications, but at least they don't resorb and warp.

Revision rhinoplasty with rib cartilage graft is a complex yet very rewarding surgery for both doctor and the patient when done in the right hands and for the right indications. Rib offers abundance of cartilage which can be essential when more robust structural grafting is required, a limitation of residual septal cartilage and ear cartilage in many of such cases.  There are generally 2 types of risks associated with grafting, one related to the donor site and the second is with regard to the recipient site.Significant donor site risks include the potential cosmetic issues with the placement of the scar under the chest, chest pain following the surgery, and risk of lung puncture (albeit very rare).Major risks related to the recipient site include small chance of warping, resorption, displacement, stepoffs, and harder texture of the material compared to the original nasal cartilages. In order to avoid the donor site morbidities, some experts have been using cadaveric rib cartilage (removed and processed) with very similar success and recipient site complication rates which makes this option an attractive alternate to the patients own rib.