im really concerned that my rib columella strut will resorb. why are doctors' opinions so different on this issue? i requested to my surgeon maybe we could use a implant in the tip. he says that i will get infection. i want this to be my final revision rhinoplasty but i am just so confused on this issue.
Doctor Answers 7
Rib cartliage graft
Most rib grafts do not resorb after they have been placed in the nose. When a rib graft is placed as a columellar strut it will make the nose much more firm, woody, and hard. Infection in the nose from a rib cartilage graft is very rare.
Resorption of rib
Autologous (obtained from your body) rib cartilage rarely resorbs whereas cadaver rib cartilage may resorb either partially or completely - especially if infected. Synthetic Implants in the tip/columella are best avoided if possible.
Rib cartilage does absorb unevenly
I have performed Rhinoplasty for over 20 years and it was common knowledge back in the 1980's when I trained that rib cartilage, rib bone and bone from the outer table of the skull all dissolved and did so unevenly. This has been reported in the scientific litearature, so I am also surprised when I read and hear about Rhinoplasty surgeons using this material.
IMHO, the following materials are the best:
- Conchal ear cartllage for the nasal tip
- Silastic straight dorsal implants for the nasal bridge***septal cartilage can be used for the bridge but typically it's not long enough to cover the entire length of the nasal bridge.
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Rib cartilage resorption
When your own cartilage is used I have found that graft resorption is very rare. A more common problem with rib cartilage is when cadaveric rib is used, though reports by some surgeons do show very good long term graft take with this product as well.
I agree with avoiding synthetic implants (e.g. medpore) in the tip as I prefer using your own tissue, though some surgeons are proponents of its use.
Rib cartilage for rhinoplasty
There are two reasons cartilage grafts resorb: inadequate blood supply and inadequate fixation. If your surgeon is recommending rib cartilage I assume that a significant structural defect exists. If not, there are less biologically "costly" options available, such as ear or septum.
Revision rhinoplasty can be difficult due to scaring in what is otherwise a very delicate space. Make sure your surgeon has enough experience in this type of undertaking to maximize the chances for a good result.
Rib cartilage and septal cartilage can resorb a bit. Usually they hold up very well for the long term.