Is rib cartilage necessary for my Ethnic Rhinoplasty? (photo)

Question

I'm between 2 doctors for my Primary Ethnic Rhinoplasty. One usually doesn't use rib for his ethnic patients unless he feels it's necessary . The other mainly uses rib for almost all his ethnic patients. I want a defined bridge and slimed nose tip, and slightly reduce width. Getting conflicting information online. I prefer not to use it if I can avoid it but not if it won't get me results that will make a noticeable difference.

Mark Beaty, MD · Answer

Rib cartilage may be necessary for ethnic rhinoplasty, depending on the nasal structure and goals. Many ethnic noses have thicker skin and weaker underlying cartilage, so using rib cartilage can provide more substantial support and definition, especially for building a higher, more refined bridge or projecting the tip. However, not every patient needs it—some surgeons can achieve your goals with septal or ear cartilage if enough is available. Ultimately, it depends less on the ethnicity label and more on your unique tissue, support, and aesthetic goals.

Larry C. Leverett, MD, FACS · Answer

In contradistinction to Caucasians, as African Americans, we often have lower dorsums,  wider noses and thicker skin. So the usual remedy is to build up the dorsum, narrow the nose and suffer with the thick skin. Because our skin is thicker, we, like Asians and some thick skinned Hispanics tolerate on-lays (out of the box) which extrude in most Caucasians and other thin skinned people. I have never had a prosthetic on-lay extrude from a Black patient but I have removed many from Caucasians, Latinos, and thin nasal skinned Asians. If you want autologous augmentation (your own tissue) the fascia (tissue underneath the scalp), wrapped around ear cartilage, in my opinion, is a better option because it doesn't hurt,  doesn't warp, cannot cause pneumothorax (lung collapse) and a doesn't put a permanent scar of the chest, which may be important more so in females. 
  Additionally, if you pull the dorsum forward enough, you may find that the bottom of the nose narrows enough to avoid an incision used to otherwise narrow the nostrils.

Gary M. Horndeski, MD · Answer

Rib cartilage may not be necessary. If cartilage is needed, you can consider a cadaver donor. This is more expensive but is an alternative. You can do a rhinoplasty and use septal cartilage instead of using any rib or cadaver cartilage.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Tanveer Janjua, MD · Answer

The most important question you need to ask is if you want to maintain your ethnic nose. Using rib cartilage and a pointy tip might give you a caucasian type nose. You have the option to just do Alarplasty and make the nose more pleasing and maintaining the ethnic look.
Regards
Dr. J

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. I prefer to use your own septal cartilage in my practice. Based on your photograph, you may benefit from a tip refining rhinoplasty. Your surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Fascial grafts may also be used to help improve tip refinement. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

William Portuese, MD · Answer

Rib cartilage is not necessary for a primary rhinoplasty unless you're trying to build the height of the bridge the nose extensively. Your side profile looks great, so no grafting is necessary. Osteotomies placed in the nasal bones can accomplish narrowing the bridge line . And Alar plasty accomplishes narrowing wide nostrils. Placement of any grafts in the nasal tip is only gonna add more bulk, not refinement and keep in mind that your thick skin is going to prevent refinement in that area of the tip itself.

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