Rebuilding the nose: second rhinoplasty procedure.

Question

I am looking to rebuild the nose after a disastrous primary result. Cartilage grafting will be employed. Which is best to use: rib or ear? Thanks.

Manish H. Shah, MD, FACS · Answer

Hello,Thanks for your question. Looking at your previous questions, it sounds as if you are only 1 month postop from your primary rhinoplasty surgery. As you may already know, it will be another 11 months until your nose is completely healed. By your description, it sounds as if you are concerned with an over-resected dorsum. You have asked about the use of rib vs. ear cartilage for revision rhinoplasty. For bridge augmentation I prefer to use rib cartilage. In fact, I prefer to rebuild the bridge using diced cartilage-fascia grafting. With this procedure, I take rib cartilage and morselize it into tiny pieces. I then wrap the diced cartilage in temporalis fascia soft tissue from your temporal hairline area. This makes a tissue implant that is gorgeous and natural looking when placed into the nasal bridge. 40% of my rhinoplasty practice involves revision rhinoplasty cases. I have a specialization in rhinoplasty surgery and would be happy to answer any further questions at my office in Denver.Good luck,Dr. Shah

Alejandro Nogueira, MD · Answer

Rib cartilage can be too hard, sometimes unadaptable, if not well harvested can be curvy, etc; primary options are ear and septum, always, also temporal fascia.

Robert Kotler, MD, FACS · Answer

Dear B_collins in Ohio   City, CO: 
  
     Whether or not to use rib or ear cartilage really depends on the circumstances and I would not want to offer you an answer without the benefit of having consulted.  I am sure all surgeons would feel the same way.  Rhinoplasty or revision rhinoplasty are aesthetic exercises and one that requires artistry.  No two surgeons have the same sense of artistry.  You may be helped also, ultimately, by fillers, temporary or permanent, and you should check that out.  
  
Do your homework.  Since you are dissatisfied with the first rhinoplasty, let’s hope that the second will be your last.  
  
     Best wishes,
  
 
  
Robert Kotler, MD, FACS 
  
Over 4,500 nasal procedures performed

David Reinstadler, MD · Answer

It is impossible to say which is "better" without knowing what will be done with the cartilage. Rib is much better for strength but can also cause more bulk. Ear is great for some things but very flimsy. You would need to speak with your revision rhinoplasty surgeon directly to know what the cartilage will be used for. Best of luck

Jay Calvert, MD, FACS · Answer

Rebuilding the nose in a secondary situation is a specialized procedure best handled by someone who does this type of operation on a regular basis.  Rib cartilage is my preference in most cases of secondary rhinoplasty where SIGNIFICANT rebuilding is necessary.  Otherwise, ear cartilage or septum are both good choices, also.  A thorough evaluation is necessary to make a clear plan.

William Portuese, MD · Answer

A thorough internal examination of the nose is required  in addition to the operative report from the primary rhinoplasty to determine how much cartilage is left on the inside of the nose for grafting purposes. Nasal cartilage is always the primary grafting source for revision rhinoplasty. Ear cartilage is also acceptable. Rib cartilage is rarely required

Rebuilding the nose: second rhinoplasty procedure.

Answers (6)

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