What's the Possibility of Getting a Successful Revision on a Rib Graft Rhinoplasty Revision. My Situation is Dire.

Question

Ivan Wayne, MD · Answer

You do not elaborate on why your situation is dire. You also did not include photos or a history describing your situation. I am a big fan of using rib grafts when structure is missing from trauma or a prior rhinoplasty and there is not enough septal cartilage to use.I find the strong straight pieces of rib to be excellent for rebuilding the bridge of the nose that has collapsed and formed an inverted "V" deformity after a rhinoplasty. We rarely see complications with the use of rib grafting. On a female the scar is nearly invisible as we place it in the same location as plastic surgeons use to place breast implants. The biggest patient complaint is soreness in the chest for several weeks after to cartilage is harvested. The most difficult part of the surgery is deciding how to carve the grafts themselves. One wants them to be large enough to correct the collapsed area without making the nose look too big or wide. I think that there is some resorption over time and I try to make the grafts slightly over large to compensate for this.

	I feel strongly about using only natural materials in the nose during rhinoplasties. There is less risk of extrusion and infection with natural grafts over the use of synthetic or non-living tissue grafts. We have a very high success rate with the use rib grafts in revision rhinoplasties. We have never had an infection, extrusion or warping when these grafts are used to correct inverted "V" deformities.

	I think the most important thing to consider when undergoing a revision rhinoplasty with rib grafts is the selection of an experience surgeon who can show you typical results with before and after photos.

Thomas A. Lamperti, MD · Answer

Depending on your specific needs your own rib cartilage can provide a great source of grafting material that can have excellent long term results when used properly. There are several nuances to carving and using the cartilage that help prevent some of the common problems of warping and resorption. Consult with a few rhinoplasty experts who have experience using rib and performing revision rhinoplasty.

Sam Naficy, MD, FACS · Answer

Many times rib grafts are exactly the best solution for noses with lots of problems.  You need to find a surgeon with experience in both revision rhinoplasty and rib grafts

Mark B. Constantian, MD, FACS (retired) · Answer

Rib cartilage makes an excellent building material for noses but must be indicated--meaning that you have no better donor sites.

	Rib also varies with patient age. In young patients (under 40), rib is white and elastic, so it can curl after surgery and may need revision. Over 40, it begins to get calcified and therefore keeps its surgical shape more easily.

	I am not sure what "dire" means, but if your nose has healed from the last surgery, find a surgeon who can show you results using rib cartilage that you like, and is someone you can  trust.  You want to minimize the chances of another disappointment.  Good luck!

Francis R. Palmer, III, MD (retired) · Answer

IMHO, after performing Rhinoplasty and revision Rhinoplasty for over 20 years, rib grafts, bone grafts and banked, irradiated cartilage all historically dissolve unevenly over the years.  Do a medline article search on irregular absorption of rib grafts for a more detailed picture but I do not use these grafts in Rhinoplasty and have had to remove partially dissolved grafts of rib, bone and banked cartilage and replaced them with stable, more reliable straight silastic nasal implants for the nasal bridge and conchal ear cartilage grafts for the nasal tip.  Have a few more consultations, IMHO.

What's the Possibility of Getting a Successful Revision on a Rib Graft Rhinoplasty Revision. My Situation is Dire.

Answers (5)

Answer: Rib is excellent for rhinoplasty but has strong internal stresses

Answer: Rib is excellent for rhinoplasty but has strong internal stresses

Answer: Rib grafts are a no go for revision Rhinoplasty

Answer: Rib grafts are a no go for revision Rhinoplasty

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Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.

What's the Possibility of Getting a Successful Revision on a Rib Graft Rhinoplasty Revision. My Situation is Dire.

Answers (5)

Answer: Rib is excellent for rhinoplasty but has strong internal stresses

Answer: Rib is excellent for rhinoplasty but has strong internal stresses

Answer: Rib grafts are a no go for revision Rhinoplasty

Answer: Rib grafts are a no go for revision Rhinoplasty

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Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.