Comparing consults for revision rhinoplasty. Rib/ear cartilage? Cost difference? What else should I consider? (Photos)

Seems to me that your nose needs an elevation and re-shaping of the tip, and smoothing of the bridge. Putting a big piece of cartilage in the bridge would make your nose look far too large. Maybe the rib and ear cartilage are being planned for some other area, but I don't see it.I made a morph of your current posting: Click on the "Learn more" link, just below my response, or go here:
FacialSurgery.com/RealSelf/RealSelf_Sanders2.html
Here is the previous morph I made from a previous post.FacialSurgery.com/RealSelf/RealSelf_Sanders.html
You'll see in the animation of the latest profile view that I *lowered* the bridge, rather than elevating it. I even think your nose would look good if it were a little smaller than the morph!I usually don't answer two questions from the same patient, but I was concerned that you make sure you know where these surgeons are planning on putting the cartilage, and that they made morphs to show you their goals.

You need to be examined to give you a valid response, but your pictures show a long nose with some tip irregularities and collapse of the right upper lateral cartilage which could be the cause of internal valve obstruction. I don’t think you need a rib cartilage graft. The septum could be used for spreader grafts to open the internal valve on the right. If the septum is not available, ear cartilage is the next option. The tip needs to be lifted a bit to shorten your nose and the tip cartilages need to be reshaped. $10,000 is a good total fee and you should keep whatever the insurance pays.

Experienced matters the most when choosing a  facial plastic surgeon for revision rhinoplasty.  In our practice, rib cartilage is rarely  ever performed.  There should be enough cartilage left over on the inside of  your nose or ear to perform a closed revision rhinoplasty procedure.  Placement of a rib into the nose makes it feel very hard and unnatural.  Continue to do your homework

Thanks for your question. If you were my patient, we'd be talking about doing a lot of grafting to try to build up your dorsum and fix what's going on with your nasal tip. Structural grafting like you'll need to correct your middle vault collapse needs to be strong- either septal cartilage or rib cartilage. Since you've had surgery before you may not have adequate cartilage in your septum, which means rib is an option. Using cadaveric instead of your own is really up to your surgeon and what they're comfortable with. I will use cadaveric in anybody over 40 years old. Younger than that, I favor using your own. Rib cartilage can warp, so that's a risk we take. I haven't seen it happen in my practice yet, but it can happen.I like using ear cartilage to help reshape the lower 1/3 of the nose. It's a little softer and the contour is correct.If you're having breathing issues, that is a legitimate thing to submit to insurance. In picking a surgeon, you can consider several factors. In this case, experience probably trumps everything else. This is complicated work so you want to go with someone with a track record of success in these situations. You should expect to have improvement from revision surgery, particularly if you're having breathing problems. However, you should know that revision surgery may not get you a perfect nose. Scarring from your prior procedure can limit what's possible from an aesthetic perspective.For an example of a revision using her own rib and ear cartilage, check out this example from my photo gallery. Good luck!

Hi,Septal or ear cartilage should work fine. Also just reshaping the cartilage you already have in your tip should work well too. If you have nasal valve collapse or nasal obstruction from a deviated septum , depending on you insurance coverage, some of the cost could be defrayed. 14K seems high  and 9k seems more within reason but choose the surgeon you think will do a better job.Best,Dr.S.