Combine Rhinoplasty and Otoplasty for Less Scarring?

I am considering two procedures: a Rhinoplasty and an Otoplasty. I can't afford to have both procedures at the same time. I went for a consultation with a plastic surgeon for the Rhinoplasty and he said that he will probably need to harvest some cartilage from my ear to support my nose after performing an open Rhinoplasty.

Which procedure should I do first and does the order matter? Will I end up with less scars on my ears if I did the Otoplasty and Rhinoplasty at the same time, or will I have the same scars regardless if I had the operations six months apart due to cost reasons?

Doctor Answers 15

Same scarring regardless of separate or combined rhinoplasty with otoplasty

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Rhinoplasty and otoplasty can certainly be done at the same time. Harvesting a small piece of ear cartilage for use in the nose does not constitute an otoplasty. Generally speaking, the same incisions are made for harvesting ear cartilage as is made for an otoplasty procedure. The same scars will be there regardless of one or two different operations.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

No difference in scarring

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For the patient who requires cartilage grafts while undergoing a rhinoplasty, the most common choice is the septum which is the cartilage between the two sides of the nose. Other choices are the rib cartilage as well as ear cartilage. The ear cartilage is removed, through an incision behind the ear,which is also the incision used when performing an otoplasty. If you cannot have both procedures done at the same time, and if you're surgeon has to use your cartilage, he will use the same incision when he goes back and to perform the otoplasty.

Joseph M. Perlman, MD
Houston Plastic Surgeon
4.3 out of 5 stars 27 reviews

Rhinoplasty or Otoplasty: which goes first?

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I would agree with the vast majority of surgeon's here that you perform the rhinoplasty first if you need to stage the procedures. However, performing the two procedures separately may actually cost you more than performing both at the same time. There are many shared expenses which will save you money if you can have both perform at the same time.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Rhinoplasty and Otoplasty

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Most rhinoplasty surgeons prefer to use the patient's own septal cartilage for grafts, which is borrowed from the central portion of the nasal septum. For revision rhinoplasty in which the septal cartilage has already been used, surgeons frequently will use ear cartilage or rib cartilage.

If your rhinoplasty surgeon needs to use ear cartilage for your rhinoplasty, dont have an otoplasty performed first (unless it is performed at the same time) because an otoplasty will likely remove, damage, or limit the amount of available ear cartilage.

C. Spencer Cochran, MD
Dallas Facial Plastic Surgeon
4.7 out of 5 stars 149 reviews

Rhinoplasty before Otoplasty

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It is unfortunate that you can not get both procedures done on the same day. If you have to choose one first, I would recommend that you get the rhinoplasty. The reason is that the surgeon may be able to harvest enough cartilage from your nose to perform the procedure. If additional cartilage is needed, the surgeon can harvest from your ear. The scars should not be a factor if the otoplasty is approached from behind your ear.

Kevin Ende, MD
Manhattan Facial Plastic Surgeon

Otoplasty and rhinoplasty

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 A rhinoplasty and an otoplasty can be performed at the same time.  Yes, while harvesting cartilage grafts from the ear, the otoplasty can be performed.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Scars not an issue

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I would recommend that you get the rhinoplasty first. The reason is that all the needed cartilege will be harvested. Next, the doctor can shape the ear without worrying about cutting ear sutures and distrubing the otoplasty. The scars will not be a factor in the decision.

Finally, your doctor will also weigh in on the surgical order. One thing I did not consider is what is most important to you. Likely, this is what you will want to fix first. I would think you can hide the ears easier than the nose.


Rhinoplasty and otoplasty are a sensible combination

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Ear cartilage is an option in secondary nasal surgery if the first procedure has removed all of the usable septum. The septum is the first choice because it is readily available in the nose and an additional site or 'scar' is unnecessary. It can be difficult to judge in revisionary rhinoplasty what is available, and what will be needed to provide shape and support and being prepared ahead for ear cartilage if necessary is a good idea.

Concerning otoplasty, as a routine cartilage in not removed as the ear is folded and shaped by scoring and bending the cartilage within the ear. The scar or incision used in otoplasty is in the fold behind the ear and is very difficult to see. When cartilage is removed for a nasal graft, it should be taken from and area where it will not 'show', in the deep hollow area called the concha. This should not upset the otoplasty result, and as a combined procedure simplifies the issues as the surgeon is already there ( the incision has been made in order to perform the otoplasty and the cartilage to borrow is in plain view). I think that both you and the surgeon will be better off combining the procedures rather that opening the ear twice.

Cost savings may be on the table. It wouldn't hurt to ask.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Rhinoplasty should be first

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You should do the rhinoplasty before the otoplasty. If the surgeon really needs cartilage from your ear for your rhinoplasty, then it would not make sense to do the otoplasty first. Otoplasty involves cutting and bending the cartilage in your ear which would make it useless for the rhinoplasty procedure. Good luck with your surgery.

You should do the rhinoplasty firsst.

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 Usually we are able to get all the cartilage we need for the rhinoplasty from the septum, unless this has been done before. Therefore, do the nose first or and the ears later.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.