Adding Rib Graft to Make Nose Bridge Larger?

I had Rhinoplasty and my surgeon cut the nose and made my bridge small. If I want it larger, is there a way to ADD a rib graft? Or would it have to be replaced completly? Can the nose be made as big as the patient desires, or are there limitations?

Doctor Answers 15

Role of Rib Grafts in Rhinoplasty

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The role of rib grafts in rhinoplasty is to add significant dorsal augmentation, projection, and for reshaping especially in ethnic noses or secondary rhinoplasty. This does require an additional donor site. It has some discomfort, but it is overall a good operative procedure that must be done in the hands of an experienced rhinoplasty surgeon.

Dallas Plastic Surgeon

Nose bridge can be made larger rib graft

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Since you have already had a reduction rhinoplasty, it is best to wait at least a year before embarking on further rhinoplasty procedure. If indeed you do want the nose larger, there is a way to add cartilage to the nose to build up the bridge. The first alternative would be to use nasal cartilage, and the second alternative would be to use ear cartilage, and the third alternative would be a rib graft. It is impossible to make the nose too big, and there are limitations to the skin envelope of the nose. If too much cartilage is placed in there, the blood supply to the skin gets compromised and necrosis can ensue. It is important to not place too much tension on the skin.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Raising a Low Bridge with Rib Grafts

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In revision rhinoplasty, it is usually necessary to reconstruct and reshape the nasal framework using cartilage grafts. Because available septal cartilage has usually been removed during the first surgery, grafts must obtained from another site - either the ear or the rib.

Rib cartilage has many uses and advantages in revision rhinoplasty. It can be carved or shaped to the desired configuration. Its rigidity can provide support to a weakend nasal framework. It works particularly well for building up (augmentation) a low bridge.

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

Rib Grafts in Nasal Surgery

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The bridge can be enlarged using cartilage grafts, but I prefer to harvest the cartilage from the nasal septum or the ear. Rib grafts are my last choice because this approach is more difficult for both the surgeon and the patient. 

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Nasal grafts

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If the bridge of the nose is flat or low, then a cartilage graft can be used to augment this area.  There are always limitations to how large a graft can be put in becuae of the skin envelope.  A rib graft is usually best if a large graft is needed.

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

Graft to nose

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Hi, rib graft can certainly be used to augment the bridge of the nose. We also use the septum and sometimes cartilage from the ear. You can go larger, but keep in mind that your skin will only tolerate so much underneath, so there is a limit to how large you can go in that sense. In some cases, the nasal tip is very large in relation to the rest of the nose, and this makes the dorsum of the nose seem small. In that case, you might just need to have the tip reduced. in any case, you should find someone qualified and experienced in your area who can discuss your desires with you. Good luck! /nsn

Rib grafts for dorsal augmentation.

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Cartilage grafts are often used to rebuild the nasal bridge in cases in which too much was was taken during a previous surgery. Although rib cartilage may be required, most surgeons use this in cases in which other sources of cartilage (septum or ear) are not available. If it is needed, it can be an excellent choice, however, the surgeon must be experienced in order to prevent potential complications.

Amir M. Karam, MD
San Diego Facial Plastic Surgeon
4.7 out of 5 stars 124 reviews

Rib graft is the most aggressive option, but is necessary sometimes

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Cartilage grafting is the best way to augment the nose. It is the least likely to have infection and rejection issues. The progression of cartilage grafting is usually nasal septum, ear cartilage, then rib cartilage. Septal cartilage is the most accessible but often is limited in quantity. Significant nasal bridge augmentation may require more than what the septum can offer. Ear cartilage offers more but the bend in ear cartilage makes it less attractive for the nasal bridge but can be used for small augmentations. Rib cartilage usually is needed when the nasal bridge needs to be raised a significant amount.

When you start to consider the whole nasal bridge and if it is more than 2-3mm in change, you should start to consider rib as an option. You can also consider a silicone implant. Although this is a foreign object the rejection is really low if the implant is done right. There are limits to how big you can make your nose. The limiting factor is the skin envelope and the lining of the nose. Making it much bigger than what it used to be is hard. There is really no science that is out there yet to determine how much bigger one can make the nose. An adequate release of the tissues to allow the rib or other graft to expand the skin is necessary.

Philip Young, MD
Bellevue Facial Plastic Surgeon

Rib cartilage graft is a good option

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I agree with some of the comments from the other surgeons that a rib graft could be used in the absence of sufficient septal cartilage. The rib cartilage will provide more than enough tissue for enlarging your nose and provide support that is not achievable with other grafts such as ear cartilage. Your surgeon does need to be experienced with this procedure in order to achieve a good result. The limitation in making your nose larger is the skin of your nose; one does not want to stretch it to the point where it may die! Rib cartilage grafts do not resorb if properly placed and the results can be very predictable (I have taken out a broken cartilage rib graft, and replaced with a new one, in an 81 year old patient who had her original operation 51 years before!). Good luck.

Dr. Gantous

Andres Gantous, MD
Toronto Facial Plastic Surgeon
4.9 out of 5 stars 28 reviews

Rib Grafting

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Yes, a rib graft can provide autologous (your own) support and contour enhancement to your nose. I use rib grafts when local resources are either depleted or their harvest would destailize the infrastructure of the nose. I prefer nasal septal cartilage but in many of the revisions I perform, the septal cartilage has already been used. I therefore typically move to the ear as a source, unless the ear cartilage is not adequate.

My advice is to find a board certified Plastic surgeon with extensive exprience with reconstructive/revisionary cosmetic nasal surgery. Have them take a look and advise you accordingly.

Good luck!

Dr. C

John Philip Connors III, MD, FACS
Atlanta Plastic Surgeon

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.