Rib Cartilage Okay on Top of Artefill for Nose?

 I had permanent filler Artefill injected into my nose around the nostrils and middle nasal area - quite a lot like 2cc. My surgeon used a micro-cannula (a small, rounded tip needle) and he injected correctly and NOT superficially. I am really happy with the Artefill and want to keep it in my nose - but I still want to do one last revision rhinoplasty using rib cartilage to build up the nose and make it bigger. Is there any problem performing that kind of surgery with Artefill kept in the nose?

Doctor Answers 12

Revision rhinoplasty to place rib cartilage on top of Artefill


There have been many problems with fillers placed in the dorsum of the nose, especially when it is a significant amount.  Proceeding with any type of revision rhinoplasty surgery will certainly disrupt some of that Artefill in the nasal bridge when inserting a graft.  There is always a chance of complications from the Artefill that may necessitate removing the rib cartilage graft.  If your nose looks adequate at this point, you should probably leave well enough alone.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

The risk of using rib cartilage on top of Artefill is unknown

The risk of using rib cartilage on top of Artefill is unknown.

What's the problem with your nose? Be careful about trying to do too much.  Too much nasal surgey can lead to major problems.

Also, cartilage grafts have to be taken out of your chest whcih adds new scars and new risks. If you are pretty happy with the way your nose is now, don't do anything more.

G. Gregory Gallico III, MD
Boston Plastic Surgeon
3.2 out of 5 stars 7 reviews

Rib Cartilage and Artefill in Nasal Surgery

I'm not aware of any studies on the combination of  Artefill and rib cartilage used together in the same part of the nose during rhinoplasty surgery. It can be done , but the risks are uncertain. You should have an honest discussion with your surgeon before making a decision.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Rib cartilage graft after Artefill

Good question!  No one can tell you for sure, but if you elevate the soft tissues and provide a good bed for the cartilage graft to take to, then it should be ok. 

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Permanent Fillers in Nose Are Controversial

It is completely up to the surgeon's preference. There are conflicting views about the use of permanent fillers in the nose or anywhere on the face. Artefill and Silicon are permanent fillers. If your physician feels it is safe and has extensive experience with it, then it is her/his choice.

I do not use any permanent filler as the risk of a permanent problem is always there.  Safety is the first goal.


Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 107 reviews

Science, not voodoo, please.

What a bunch of unscientific nonsense! My colleagues would gladly advise in favor of surgery (with a 5% to 10% revision rate, the use of permanent sutures of nylon, the use of permanent titanium screws, etc.), and yet have a negative opinion of Artefill...with NO scientific data...only fear-mongering...to support that opinion.

That Artefill is "unknown how it may effect the blood supply in the areas where it was injected" is purely false. That one can predict surgical revision, especially with cartilage grafts, better than Artefill is also untrue (warping, resorption, etc. all are possible with cartilage). That it can't be undone is also at odds with the data. The interim safety study on Artefill has shown 4 granulomas in 1,008 patients (0.4%). All have responded completely to treatment without resorting to any surgical intervention. The real world data shows 4 granulomas among 20,000 patients (0.02%). Artecoll--an arguably inferior predecessor--has been used in hundreds of thousands of patients with fewer adverse effects than rhinoplasty.

I do rhinoplasty, revision rhinoplasty, and I also use Artefill. They both have useful and often complementary roles in the nose and elsewhere on the face. There are always risks, and greater care has to be taken with surgery after Artefill to ensure good contour. If someone can produce convincing SCIENTIFIC EVIDENCE--not voodoo nonsense--about this, please step forward. Sheesh!

</rant-off> :-)

All the best,


David C. Pearson, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 24 reviews

Artefill and rib cartilage for the nose.

The problem with fillers like Artefill is that they are permanent and no one can tell you if you will have a problem with it years later. See an experienced rhinoplasty revision surgeon for evaluation.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Avoid Artefill in the nose

Artefill and other "permanent" fillers should be strictly avoided in the nose.  The skin is thin and capsular scar tissue can be felt and seen around the particles.  Infections can occur but unlike implants (which I also dont like in the nose) the artefill is not completely removable.  It just opens up a can of worms and the risk is not worth taking.  Consider either using cartilage, fascia or restylane/Juvederm.

Shervin Naderi, MD, FACS
Washington DC Facial Plastic Surgeon
5.0 out of 5 stars 106 reviews

Rib cartilage on top of Artefill for nose

Great question. I also feel the combination has some concerns. I have used Artefill and also use rib cartilage grafts BUT never both in the same area. Most likely there should be no issue but we as experts really do not know.

Sorry, from MIAMI Dr. B

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Nose Augmentation with Artefill AND Rib graft

As a Plastic surgeon we are trained to always have an alternative (or as Dr. Millard used to say a "life boat") should an operation fail or have a major complication.  Although it COULD be done, using a permanent filler such as Artefill in the nose is not a great idea since it can never be reversed. Artefill contains grains of PMMA (polymethylmethacrylate - a shatter resistant acrylic found in Plexiglass, Lucite and used as bone cement and intraocular lenses) mixed with Beef collagen (requiring a pre-treatment skin sensitivity test to prevent injection in beel allergic people). If usually is associated with a scarring reaction.

Good or Bad - this filler cannot be removed without a major operation. Adding ANOTHER graft to the same location MAY work or may fail with dire consequences as non-living grafts CANNOT fight an infection and have to be removed.

i would advise you to seriously re-consider.

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 108 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.