Had Rhinoplasty using rib cartilage to build my dorsum, now I need a revision. What's the best option please?

Same plastic surgeon is recommending medpor implant or bone graft from my temple since I'm having a forehead reduction as well. What would you recommend?

Doctor Answers 5


Dear EM1977 Toronto,

Secondary reconstructive aesthetic rhinoplasty can be fraught with complications and a proper preoperative plan together with your selected operative facial, plastic and rhinoplasty surgeon is important. There are many reasons why the rib graft would have failed to contribute to the nasal dorsum that gives you optimal balance and proportion. There are other autogenous bony support options, selected from the skull; from the hip; or from the rib. There are also artificial options for bony bridge reconstruction, such as Medpor® or silicone support structures. What’s best in your specific scenario requires careful consultation with a surgeon experienced in these types of aesthetic reconstructions and then careful planning and operative execution.

I would seek the consultation of surgeons familiar with this kind of reconstruction and in Toronto, there are many of them. Dr. Oley Antonyshyn at Sunnybrook and Dr. Jeff Fialkov at Sunnybrook Hospital perform a lot of reconstructive rhinoplasty procedures, as does Dr. Phil Solomon. I think with these physicians you should be in good hands and a careful selection of the techniques that make the most sense in your given situation need to be explored.

For more information, please review the link below.

I hope this information has been of some assistance and best of luck.

R. Stephen Mulholland, M.D.
Certified Plastic Surgeon
Yorkville, Toronto

Toronto Plastic Surgeon
4.7 out of 5 stars 80 reviews

Had Rhinoplasty using rib cartilage to build my dorsum, now I need a revision. What's the best option please?

The best option for nasal augmentation depends on your age, the thickness of your skin, and the reason that you need a revision operation in the first place. Was the previous rib cartilage graft insufficient to raise the bridge of your nose? Has your rib cartilage warped over time? Did the cartilage shift in position? Are the edges of the graft visible or irregular? As for the options presented, I have had success with cranial bone grafts in the past but I tend to avoid Medpor. The latter is difficult to remove or adjust, is prone to infection, and can appear hash or unnatural when used on the dorsum of the nose.  I prefer septum or rib cartilage for the dorsum whenever possible. Consider posting your photos for more specific recommendations.  Best Wishes

Brock Ridenour, MD
Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 96 reviews

Rhinoplasty revision

Not sure why you need a revision or why you would take out the rib cartilage graft.  More information is needed. I am not a big fan of medpor nasal implants, because they can get infected more easily than other implants.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Had Rhinoplasty using rib cartilage to build my dorsum, now I need a revision. What's the best option please?

It is hard to answer your question without photographs. While it is not wrong to use Medpore or cranial bone, most of us who specialize in rhinoplasty prefer septum or rib cartilage for augmentation of the the bridge of the nose. If you post your front, profile and head tilted back views of your nose we could advise you more meaningfully.

Bahman Guyuron, MD
Cleveland Plastic Surgeon
4.8 out of 5 stars 20 reviews

Revision rhinoplasty after rib graft

My first thought is what are the current issues with your nose that are requiring a revision?  If there is an issue regarding your dorsum, you still have options that involve cartilage for reconstruction. You can use conchal ear cartilage if this has not been used yet, or you can use another rib cartilage graft. In my practice, I use autologous tissues for revision rhinoplasty as I have seen many patients come to me who have had previous implants that have gotten infected. When using autologous tissues, the risk of infection if much lower. Again, depending on what needs to be revised within your nose will dictate the type and extent of reconstruction that will best suit you.

Best of luck.

Michael T. Somenek, MD
Washington DC Facial Plastic Surgeon
5.0 out of 5 stars 28 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.