Is It Safe to Undergo a Rib Cartilage Rhinoplasty if I Have Had Pneumothorax Once Before?

I am 22yr old Asian male and I had spontaneous pneumothorax once on my right lung when I was 17 and had to undergo a pleurodesis in order to be treated. Currently I want to have rhinoplasty to heighten the bridge using rib cartilage. As pneumothorax is one of the risks involved in harvesting rib cartilage, will a history of pneumothorax create an increased risk of this occurring? Would it be okay to harvest from the left chest instead?

Doctor Answers 16

Rib Graft

I would recommend other graft materials such as your ear cartilage (conchal graft). It would be advisable to have a chest X-ray prior to your surgery and your surgeon should consult a thoracic surgeon to ascertain the risk of a second pneumothorax. Best to leave your ribs and opt for another site or an alloplastic graft material.

Risks of Rib Cartilage- Costal cartilage With Previous Pneumothorax

The main major risk in rib cartilage is pneumothorax.  When a patient has a previous pneumothorax there is a chance of scarring of the pleura to a superficial area which can lead to the pleura more accessible to damage.  Typically the pleura of the lung is located underneath the rib but it can be located in between the rib.  This would make a pneumothorax a higher chance in your case and may mean considering harvesting rib from the contralateral side to the pneumothorax or using an alternative cartilage source.

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.

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 163 reviews

Rib cartilage harvest and previous pneumothorax

A previous pheumothorax should not put you at any further risk for developing another one.  Certaily harvesting of a rib can cuase a pneumothorax but it is rare.

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

Rib Grfts and Pneumothorax

There is probably no real connection between your prior spontaneous pneumothorax and one caused by harvesting a rig graft. As long as a puncture is recognized the danger is low. You might want to consider other methods of dorsal augmentation, such as diced donor cartilage wrapped in fascia. This has been a successful alternative method for raising the nasal bridge. Not every patient needs a rib graft.

Ira D. Papel, MD
Baltimore Facial Plastic Surgeon
4.9 out of 5 stars 31 reviews

Is It Safe to Undergo a Rib Cartilage Rhinoplasty if I Have Had Pneumothorax Once Before?

A pneumothorax is rare during rib graft harvest regardless of whether you've had prior spontaneous pneumothorax. With that said, pneumothorax resulting from rib graft harvest is very uncommon but easily and immediately detectable and quickly remedied. I would discuss this with your surgeon AND your anesthesiologist prior to surgery. Make sure you communicate your history clearly and seek an experienced rhinoplasty surgeon. With your history, I would highly recommend that you seek out an accredited ASC with MD anesthesiologists on the slim possibility that you were to develop another pneumothorax. I hope this information is helpful.

Stephen Weber, M.D., F.A.C.S.

Lone Tree Facial Plastic Surgeon

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
4.9 out of 5 stars 129 reviews

Prior Pneumothorax and Future Rib Graft Rhinoplasty

I see no potential connection between your prior spontaneous pneumothorax and an increased risk of a pneumothorax from a rib graft harvest for a rhinoplasty. That issue aside, when harvesting a rib graft from the lower end of the subcostal margin, the apices of the lung are well away from the harvest site so the risk is negligible anyway. But just to be extra cautious, make the harvest from the opposite side of the prior pneumothorax.

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
4.7 out of 5 stars 72 reviews

Pneumothorax with rib grafting

Any time you do a rib graft, you can get a pneumothorax.  However, by definition, a pleurodesis fuses the two leaves of the pleura that might form a pneumothorax, thus protecting you from another.  Although no guarantee, my bet is that it would be way safer to harvest from the right.


Scott E. Kasden, MD, FACS
Dallas Plastic Surgeon
4.7 out of 5 stars 101 reviews

Rhinoplasty and rib cartilage harvest

One of the risks of rib harvest is a pneumothorax. Since you have had a previous one, I personally would harvest from the opposite side to avoid any further risks to that particular lung. Good luck.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

Rib Graft after Pneumothorax

Your previous history of a pneumothorax will not increase the risks of harvesting a rib graft. You can harvest from either side of your chest.

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

Rib graft after pneumothorax

Your risk is low of rib grafting causing another pneumothorax. The general anesthesia could be a factor if you have pulmonary blebs. An anesthetist should be made aware of your history. You could also consider alternatives to rib including ear cartilage, septal grafts and gortex implants

Philip Solomon, MD, FRCS
Toronto Facial Plastic Surgeon
4.3 out of 5 stars 93 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.