What Is The Difference In Using Bone vs. Cartilage In Rhinoplasty?

hi what is the difference between bone and cartilage in rhinoplasty and what is used for where. and what is the best option to use when the patient seems to absorb any graft put in their body (septal and ear). assuming that rib is the last resort. rib bone or rib cartilage? more for ethnic rhinoplasty in for tip augmentation and projection.

Doctor Answers 12

Bone and cartilage use in Rhinoplasty

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I have performed Rhinoplasty for well over 20 years and here's my take on using cartilage and bone in Rhinoplasty IMHO.

  1. Septal cartilage and silastic straight dorsal implants work best on the nasal bridge
  2. Conchal ear cartilage works best in the nasal tip
  3. Bone, irradiated cartilage, rib cartilage, rib bone and folded ear cartilage all, IMO, absorb and do so unevenly over the years which makes them a poor second option.

Hope this helps.

Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Best Graft in Ethnic Rhinoplasty

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Gid Day Perth,

Rib cartilage is the best graft for augmentation rhinoplasty in an ethnic patient who has had all of their septal and ear cartilage used.  Diced cartilage in a wrapped temporalis fascia graft also works well depending on what needs to be done.  Good luck and be well...good on ya.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 37 reviews

Bone vs. Cartilage Graft

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It is usually optimal to use cartilage grafts in shaping the dorsum and the tip of the nose rather than bone because it can resorb bone. It can also cause more abnormal contraction around the skin in the nasal area.

Rod J. Rohrich, MD
Dallas Plastic Surgeon

Bone vs cartilage use in rhinoplasty

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Bone grafts are rarely used in rhinoplasty.  They are only used to augment the bony dorsum, which is the top portion of the nose.  Cartilage grafts are used throughout the nose including underneath the bridge and sidewalls.  Spreader-grafts and tip cartilage grafts to further bolster and thicken and give structural integrity to the nose.  It is also used for tip augmentation in either Caucasian or ethnic rhinoplasty.  

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 155 reviews

Bone vs. Cartilage

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Warping is the biggest concern with regards to Bone vs. Cartilage.  Depending on the type of defect or deficit, will determine where your grafts need to come from.

Richard Ellenbogen, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 30 reviews

Bone or cartilage

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Most surgeons have gotten away from bone grafts in the nose due to it's rigidity, difficulty in shaping and securing and morbidity to harvest (hip, parietal skull). It would definitely not be recommended for tip shaping.

It's most unusual to lose your own septal cartilage in the absence of post op infection. If you ears are used already then you definitely should consider rib if you are determined to have further surgery. One other option is irradiated donor rib cartlage. This would let you avoid the morbidity of the rib harvest incision. While mixed reports exist about  irradiated rib, several surgeons have recently reported excellent long term results and followup with it.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
4.8 out of 5 stars 12 reviews

What Is The Difference In Using Bone vs. Cartilage In Rhinoplasty?

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Bone is usually used for patients with saddle nose deformity which is collapsed nose secondary to large septal perforation. I have used calvarial bone with long term stability. For ethic noses such as Asian, silastic implant have been used with relatively low complications. If placed in the right pocket, it is the best implant. Cartilage tend to warp with time.

Mohsen Tavoussi, MD, DO
Orange County Facial Plastic Surgeon

Bone vs cartilage

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In general I prefer nasal cartilage. However, if the defect is too large as in a severe saddle nose deformity, bone is needed. Bone is hard and difficult  to shape. I also seen it move on touch.

David A. Bray, Sr., MD
Los Angeles Facial Plastic Surgeon

Grafting in Rhinoplasty

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Bone should only be used over bone in the upper third of the nose or on the bony sidewalls for reconstruction.  When used, it must be rigidly fixated or it will resorb over time.  If cantilevered off of the bone and down over the cartilaginous portion of the nose, it is too rigid and feels unnatural and is at risk for fracture if bumped.  Once fractured it will resorb.  Cartilage is the ideal choice, but it can resorb, particularly in smokers.  If you smoke, you are prone to resorption of any living tissue graft that is placed.  Alloplastic materials can be  used safely and effectively in the nose for nasal dorsal augmentation, but not in the tip.  I prefer cartilage but will use alloplastic materials in smokers to build up the bridge or dorsum of the nose. 

Gregory Branham, MD
Saint Louis Facial Plastic Surgeon

Bone or cartilage in rhinoplasty

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For both nasal reconstructive and  cosmetic surgery, cartilage is generally the ideal choice due to its properties. Bone does have some limited application, such as a cantilever graft. Certainly bone would be preferable to a silicone implant. 

Jack Peterson, MD
Topeka Plastic Surgeon
4.5 out of 5 stars 43 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.