Is it better to use ear cartilage or rib for an Asian rhinoplasty? (photos)

Question

I want a natural Asian rhinoplasty but is not sure to use ear cartilage or rib. Of course I would discuss with the doctor but right now if someone could please tell me the pros and cons of both would be greatly appreciated. And if either of them could last a lifetime. Attached below are my pictures and the last one is the nose that I wish to achieve after rhinoplasty. Any suggestion on how to achieve it would be great as well. Thank you very much.

Goretti Ho Taghva, MD, FACS · Answer

Thank you for your question.  Typically, ear cartilage is used to increase projection and refine the tip of the nose whether you use an implant/ autologous tissue for bridge augmentation.  If only a conservative augmentation is needed for the bridge, ear cartilage can be used in conjunction with temporalis fascia as well.  Looking at your photos, more cartilage may be needed than just using the ear to increase the bridge and radix height to look like your wish photo.  Longevity wise both should be similar and both may resorb a little over time.  Best to consult with Asian rhinoplasty specialists for an in person consult.  Good luck!Goretti H. Taghva MD FACS

Edwin Kwon, MD, FACS · Answer

Both rib and ear cartilage can be suitable for different things.  Your cartilage is soft and I feel that this softness is good for things like to progress as it does not feel too hard to the touch.  The main drawback for your cartilage is that it does not provide enough strength if the goal is to raise your tip with something like a septal extension graft.
In many patients, I have used a combination of more structural grafts from the rib cartilage and also a small piece of your cartilage for the tip grafts so that it does not feel so firm at the tip.  Rib cartilage is initially necessary for tip projection.  You may have enough septal cartilage that can be used for the structural grafts.  However, a lot of age and patient's have very small septal cartilages that are not initially sufficient if a big change In the tip is desired.

Kenneth Hughes, MD · Answer

Cartilage can either come from the patient's ear or rib or from a cadaver.  If the cartilage is harvested from the cadaver, it is radiated to make sure there is no chance of any kind of transmittable disease. The benefit of using the cadaver cartilage is that it saves time and the extra healing that is involved with taking cartilage from the patient’s ear or the patient’s rib.  If rib harvest is your only option, this harvest is not insignificant and has complications of its own such as warping and pneumothorax.I would use conchal cartilage grafts to create extension (for example depending upon what needs to be done) as a preference over rib graft. Septal or ear cartilage would be better than rib if the depression is modest and not as much cartilage is required. Rib cartilage can be used to recreate a dorsum in traumatic deformities.

William Lao, MD · Answer

So the decision all comes down to how much material is needed. From the pictures you have shown and the desired photo at the end, only using ear cartilage will unlikely have enough material for that look. If you add a dorsum implant plus ear cartilage with septal cartilage then it might be enough.  Otherwise rib will always provide enough material to achieve the look you want.

Donald B. Yoo, MD, FACS · Answer

Ear cartilage is sufficient for mild to moderate augmentation and change, however for more significant amounts of augmentation and change additional cartilage (and often stronger cartilage) is necessary in the form of rib cartilage.  Rib cartilage harvest, when performed by a specialist, can be performed through a minimal incision (< 1 cm) and will leave a small, well-hidden scar and does not prolong the recovery from your rhinoplasty surgery at all.

Andrew Miller, MD · Answer

Ear cartilage is not great for the bridge because it is curved. Rib cartilage may be overkill if only working on the bridge and it can possibly warp over time. With a Goretex graft, it can be carved exactly to what you want, and then it is wrapped with Alloderm to create a permanent graft that is very biocompatible. Some people may mention the risk of infection, but with a properly performed procedure the risk of infection is extremely low.

Sean Fisher, MD · Answer

From a structural standpoint, rib cartilage will provide much more support than ear cartilage. Ear cartilage can be used in instances where smaller amounts of dorsal augmentation or isolated radix augmentation are needed. However, in terms of controlling tip projection and de-rotation, it is not strong enough to ensure a long-term stable result. For these maneuvers, rib graft will provide much greater control for long term maintenance of your result. 
Sean Fisher Aesthetic Plastic Surgeon

Joshua A. Halpern, MD, PA · Answer

When performing an Asian rhinoplasty I first examine to see if I can use septal cartilage, which is located inside the nose. If there is not enough cartilage then I prefer to take cartilage from the ear. If one wants to augment the bridge of the nose I prefer split calvarial (scul) bone graft or artificial material since rib cartilage graft tends to partially go away with time. I hope you find this information useful. Please see the enclosed video.

Hong Ryul Jin, MD · Answer

Hi, if you want a result such as the last photo, ear cartilage is not a good option. Ear cartilage is curved, small, and weak. It is only suitable for the minor tip modification in most cases. The lateral phoptograph you provided shows you have a little short, upturned tip. To achieve lowering of the tip with projection increase, rib cartilage is more suitable to achieve the goal. In addition, you need to raise the bridge a little, and for this rib is the only choice if you don't want to use alloplast material. 
Thanks.

Is it better to use ear cartilage or rib for an Asian rhinoplasty? (photos)

Answers (9)

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