Revision Rhinoplasty - rib cartilage or fascia?

Question

Getting a revision rhinoplasty (it has been over a year since my first one) and I'm wondering which is better to use for adding to the bridge/building the bridge up; cartilage from the rib or fascia from temple area/scalp? In other words, which cartilage is the best material to use for the bridge. Also, is there any short term or long term risk/danger/harm to my health if cartilage is taken from the rib?

Steven J. Pearlman, MD, FACS · Answer

Some of the options for bridge or dorsal augmentation in rhinoplasty or revision rhinoplasty include solid carved rib grafts, diced cartilage wrapped in temporalis fasica, diced cartilage formed into a solid implant with tissue glue, synthetic implants such as gortex. IF its only a small amount I may use two or three layers of temporalis fascia. The choice really depends on how much you are looking to augment among other issues. It's best to speak with a revision rhinoplasty specialist to see which options are best for your specific needs.

Steven Goldman, MD · Answer

If a patient’s bridge (dorsum) needs to be augmented/built up, a few options exist. The patient’s own cartilage is most commonly used. Septal, ear (conchal), and rib (costal) cartilage are all options. Irradiated/sterilized cadaver cartilage can also be used. Each have relative advantages and disadvantages that should be discussed with your surgeon. Septal cartilage is used most commonly. Cartilage may be diced and placed within a thin connective tissue sheet (temporalis fascia) in a tube shape as well. Fascia by itself is generally used only in thin skinned patients to avoid irregularities. Good question. Discuss these issues with your surgeons.

William Portuese, MD · Answer

The best source of cartilage for reconstructing the nose is always going to be nasal cartilage. If there is a cartilage depleted nose, then consider ear cartilage. Fascia taken from the scalp can also be used. Harvesting rib should be your last resort.

Steven Wallach, MD · Answer

Fascia is not cartilage and it can be used mainly for camouflage under a thin soft tissue lining or used to wrap around diced cartilage grafts.  If you need augmentation then you need cartilage in all likelihood. Best of luck!

Oleh Slupchynskyj, MD, FACS (retired) · Answer

Cartilage graft would be the answer.  We have not run into any complications having this procedure done, however, I would suggest you consult with a facial plastic surgeon to learn how this procedure works and what the attendant risks are.  Make sure the Doctor is a revision rhinoplasty specialist with many before/after photos you like.   This procedure involves specialized techniques that take years of experience to perfect. Best,Dr. S.

Revision Rhinoplasty - rib cartilage or fascia?

Answers (5)

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