Best options for a tertiary rhinoplasty? Man-made Implants vs rib cartilage?

Unfortunately 7 years after revision rhinoplasty my nose has twisted and hasn't stood the test of time. The surgeon is willing to fix it but wants to use rib cartilage and I'm very uncomfortable with the risk of warping, resorption, recovery, stiffness. I received a 2nd opinion and this surgeon wants to use a very small piece of medpore near the tip and goretex around the bridge. All things being equal, which would stand the the test of time with minimal risk? How high is the infection risk?

Doctor Answers 6

Rhinoplasty revision

In  my opinion, rib cartilage whether your own or from a jar( irradiated homograft costal cartilage) are better options than medpor.


New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Revisional rhinoplasty

Hello and thank you for your question. The best advice you can receive is from an in-person consultation.  I do not recommend an implant in the nose such as medpor or gortex.  This has a high infection and extrustion rate in the nose.  Cartilage performs much better.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and not just a computer animation system. The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 80 reviews

Revision Rhinoplasty with Rib Cartilage

I would strongly suggest against any artificial implants in the nose.  As stated by prior surgeons, there is a high risk of infection and extrusion.  I would highly suggest a tertiary revision be done with rib cartilage, because typically revision surgeries require structural grafting for support as well as cosmetic effect. If you are concerned about warping, I would suggest a diced cartilage fascia graft "DCF", popularized by Rollin Daniel.  I use them quite regularly in my rhinoplasty practice with excellent results.  They provide excellent dorsal augmentation with little if any risk of warping.  Cartilage and fascia can also be utilized in the nasal tip refinement depending on the degree of deformity and skin thickness.  Good Luck!

Anthony Corrado, DO
Philadelphia Facial Plastic Surgeon
4.9 out of 5 stars 31 reviews

What's better? Rib cartilage or an implant

There are risks to everything we do in surgery. It sounds that you have lost some structural support in your nose after your previous rhinoplasties and you require restructuring of your nose. This is best achieved with strong cartilage such as that found in your rib. The chances of resorption and warping are very small if properly used. Stifness can occur with any operation where structural support is required, but this can be managed with certain techniques and usually improves over time. Implants can get displaced, can extrude and can get infected 25 years after surgery and may need to be removed. They can work really well in the hands of many surgeons across the world, but they also have problems. I would recommend a rib graft, but you have to feel comfortable with your choice.

Andres Gantous, MD
Toronto Facial Plastic Surgeon
4.8 out of 5 stars 20 reviews

Rib cartilage vs implant for Rhinoplasty.

Thanks for your question.

I would have like to see your photos to better answer your question. I personally am not a fan of implants in the nose as I have seen problems with it. Your own cartilage is a better choice. Depending upon the use of the cartilage it could be harvest from your septum, ear or rib. Lately I have been using cadaver rib cartilage grafts with good outcome in selected patients. 

M. Azhar Ali, MD, FACS
Bloomfield Hills Plastic Surgeon
5.0 out of 5 stars 19 reviews

Rib

It would be best to use your own tissues.  These would have the least risk of infection.  Cartilage resorption and warping is a risk but there are ways to carve the cartilage to minimize this.  

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.