Rib Cartilage Grafts for Rhinoplasty?

I heard rib cartilage grafts can warp in the nose when used for Rhinoplasty. Is this true? What are other possible risks of using this for the procedure?

Doctor Answers 4

Risks of Rib Cartilage- Costal cartilage

Cartilage in rhinoplasty is used for support and structure to the nose. The three most commonly used donor areas in rhinoplasty are
  1. Septal cartilage (often missing in revision rhinoplasty) and made of fibroelastic cartilage
  2. Ear cartilage -softer cartilage and is elastic type of cartilage (hence softer and likely to bend)
  3. Rib or costal cartilage- firmer cartilage and similar in makeup as septal cartilage
The main risks of harvesting costal cartilage are as follows:
  • Warping-This risk can be minimized with experience of carving rhinoplasty, patients with calcifications in the rib, and the location and type of graft placement
  • Scar- The scar size can be minimized based on the patient's body type (thinner patients can have a smaller scar) and surgeon's experience with more advanced surgeon's harvesting from 1-3 cm rib scars
  • Pneumothorax- This is where a lung deflates since the surgeon is working around the rib site. This is rare but the surgeon must be able to handle this risk.
  • Breast implant violation- Patients with breast implants may be at risk for a "popped" implant although this is unlikely
Although there are some risks with rib cartilage, the benefits can often outweigh the risks as it costal cartilage is strong and abundant in younger and middle aged patients. For revision rhinoplasty, patients should seek out surgeons with experience in using rib cartilage as results may be compromised without enough cartilage or the sole use of ear cartilage in certain circumstances.


Chicago Facial Plastic Surgeon
4.7 out of 5 stars 138 reviews

Rib Cartilage Grafts in Rhinoplasty

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 weakened nasal framework

Drawbacks of rib cartilage include a tendency to warp (curve), particularly in younger patients. This can make the result unpredictable. Rib cartilage can also make the nose may feel firm or inflexible.

Potential risks of rib cartilage harvest include bleeding, scar, pain, infection, collapsed lung (pneumothorax), chest wall deformity. These complications are very uncommon, and in experienced hands, rib cartilage allows successful results in revision rhinoplasty.

C. Spencer Cochran, MD
Dallas Facial Plastic Surgeon
4.8 out of 5 stars 134 reviews

Most revisions don't require a rib graft.

 Rib grafts are only used when all else is not available and the defect is very large.See an experienced revision rhinoplasty expert and let him guide you with the pros and cons of each procedure.

Besides warping there is pain with the donor site(CHEST) and infection is also possible.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 32 reviews

Rib cartilage can warp with time

Well-shaped cartilage with internal support (K-wires) warps less frequently. Other risks for the procedure are similar for all implants and include: asymmetry, palpability of the cartilage, visibility of the cartilage, early reabsorption (for cartilage/soft tissue implants only), calcification, infection, and unsatisfactory cosmetic outcome.

Also, you will have a donor site near the crease of your breast to harvest the rib cartilage. People complain of post-op rib pain. You can get a fluid collection so a drain needs to be placed. Finally, in rare cases, you can pop the lung while trying to remove a segment of rib cartilage. This needs to diagnosed and treated immediately with a chest tube placement.

Dr. Shah

Manish H. Shah, MD, FACS
Denver Plastic Surgeon
4.7 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.