Will my nose bend back if I use my own rib cartilage?

Hi there. Thank you for your post. Warping (bending) is a risk of rib cartilage grafts. Using 'off-the-shelf' cadaveric rib helps reduce this potential risk. Good luck!

Straightening a crooked nose and keeping it straight can be a very frustrating thing. In general, if the nose used to be straight and trauma made it crooked, then there is a great chance of making it straight again. However, if the nose grew crooked then it becomes tougher. A lot of the result will depend on the technique the surgeon uses so make sure you are using a rhinoplasty specialist. Even with the best technique, there may a little crookedness in the nose, but it should be a lot better.

Great question, one of the biggest challenges in Rhinoplasty is to get a straight septum and nose. There are techniques to straighten the septum by removing it (ex situ) and rebuilding it with ethmoid bone or rib and then re-attaching it.
Now rib cartilage can warp (that is re bend). The trick is to contour the rib graft and integrate it with native septal cartilage with multiple fine drill holes and suture material to create a stable, robust and straight construct. Otherwise the rib will warp (or bend) if used entirely on its own.

rib will help to prevent your preoperative bend from reappearing. However, rib itself has a risk of bending/warping long term. I prefer to use irradiated cadaveric rib sheets to minimize the long term risk of bending. If septal cartilage is present, I always prefer that. 

Dear MarirhinoplastyIn general, rib grating is used in revision rhinoplasty when there is little to no septal cartilage left for use. although rib graft itself can warp, bending the way your nose was prior to surgery is less likely. More often than not, your nose will be more straight but not perfectly symmetric.

There are many factors that play into the choice of material when rebuilding a crooked nose.  Personally, my preference when treating a crooked nose is to use the person's own septal cartilage.  When it is very crooked, it often requires that we remove the entire septum, find and carve it into a straight replacement and then sew it back into position (extracorporeal reconstruction).  This approach is only possible if you have not previously had nasal surgery including a septoplasty in the past.  Using this technique eliminates many of the downsides to rib including warping, thick and blocky look, pain of harvest, etc.... In the link to our website are many examples of crooked noses and the majority were treated with extracorporeal reconstruction.  Hope this helps. 

While using the patient’s own rib cartilage is now commonly taught and quite expensive, there is no current data that shows any benefit over using banked rib cartilage in cases of rhinoplasty that actually need rib cartilage. In my recent experience, autologous rib cartilage is recommended too frequently, inconsistently implemented as a graft and over-charged to the patient with many cases paid as an out of pocket expense.  There are far too many “oversized noses’ with bridges too high in recent years with fad-like popular trend driven by economic forces.  In those cases that do need rib cartilage tissue banked rib cartilage offers all of the same advantages with a scar on the rib cage, pain (sometimes chronic) and risk of collapsing the lung of the patient a dangerous and potential fatal complication. I did many rib cartilage while building new ears in children born with one or both but this application in children is very different and tissue banking has come a long way in recent years. Over one half of the rhinoplasty surgeries performed at The MaasClinic are revision rhinoplasty. Many have little or no donor cartilage material left in the nose and a small percentage of these patients need augmentation. While previous published studies by our team have shown benefits in certain alloplastic materials (Vitallium reconstruction plates), homologous sterile acellular “banked cartilage” provides all of the benefits of autologous (harvested from the patient) without the significant complications listed above. Talk to your doctor about both options and see references listed. In orthopedic surgery the standard is banked tissue with ACL reconstruction. Our knee reconstruction colleagues stopped using the patient’s harvested tissue years ago and many pro athletes are the beneficiaries. 

Dear mari,Thanks for your question. This is a rather technical question and it would be good to bring this up during discussion with your rhinoplasty surgeon. In short, there is always a chance that the cartilage grafts that are harvested from the rib may warp and cause some degree of deviation. However, there are several techniques that experienced surgeons will use including carving the rib symetrically and also sandwich techniques to mitigate the warping. Correcting the deviated septum with a septoplasty and realignment can also help to ensure that the nose does not bend back after it gets straight. To put things in perspective, it is very common to use cartilage grafts from the rib to correct deviated noses especially in reconstructive rhinoplasty for trauma. I use this frequently in my practice and I do not have a problem with it. I hope this answers your question and best of luck for your surgery.Dr. Terence GohAZATACA Plastic Surgery, Singapore

I hope that you have discussed this issue with your surgeon in the time of your consultation. Solid (one piece) rib cartilage grafts have tendency in time to band (warp). However, if rib cartilage is sliced into strips or small 1 mm pieces and wrapped with fascia (patient own sheet of tissue) to form a cigarette like structure, bending is not like to happen. If you are not sure about what type of rib graft you will have discuss this issue with your surgeon again. Goof luck.

Hello and thank you for your question.  It would be helpful to view pictures of your nose.  If you have a crooked nose, then a septoplasty, spreader grafts, and septal reset may help to straighten your nose.  The material for spreader grafts can be septal cartilage in most cases and sometimes rib cartilage.  Rib cartilage can sometimes warp over time.  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.  You should be able to view numerous pictures of actual patients with noses similar to yours performed by your surgeon.  If you cannot find enough real before and after pictures, then consider continuing your search for a surgeon.

Best wishes and good luck.


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