Is there enough septal cartilage for a rhinoplasty revision?

The best choice for grafting material is always the septum if that tissue is available in sufficient quantities. Ear or conchal cartilage is the second best choice and the last choice is rib cartilage, either from you or from cadaver rib. If you need a lot of cartilage grafting the rib maybe necessary especially if you need to replace a large amount of nasal dorsum or top of the nose for correcting deficiencies. That being said if you have sufficient septal cartilage, I would recommend that route as the primary choice. You can always do cadaveric rib cartilage as a second choice to avoid an incision in the chest. Good luck with your surgery.

It would really depend on the amount of cartilage required and areas of the nose that need cartilage.  Yes, generally having rib cartilage may be firmer when used as a 'large' piece that is shaped, however there are other techniques that utilize rib cartilage in very small pieces.  Ear and septal cartilage are usually available, however, and I would ask about these details with your surgeon... 

Many surgeons prefer to go strait to rib cartilage to have an abundance and impart it is because there is variance on many grafts people use.   In general unless there is need to substantially augment the dorsum ( such as in over resected dorsal profile or saddle nose, in my hands septal cartilage is almost always sufficient, even if a septoplasty was previously done.   It is important to look at before and after pictures and an in person examination and analysis is necessary.

Without posted photos, benefit of physical exam, reading the op-report and reviewing pre-op photos, it's difficult to give the best answer. In our Practice we perform multiple revision surgeries-through closed technique, and in certain cases we utilize rib cartilage grafts. I suggest that you seek an experienced Rhinoplasty Surgeon with a wide gallery of before and after photos

Hi, and thanks for your question. It's a really great question and something with which nearly every revision rhinoplasty patient is concerned.  Generally speaking, you can get a good idea about how much septal cartilage remains during the in-person physical exam. I shine light through the septum, and use a small Q-tip to feel along it for resistance.  If it feels floppy then we know there is minimal cartilage there.  Unfortunately, imaging studies like CT scan, etc aren't very useful for showing this area well.  If we can't be sure on the physical exam, then we would expose the septum during surgery and proceed to rib cartilage only if there is clearly deficient septal cartilage.  The other option is ear cartilage, which is really nice for reconstructing the tip of the nose. My recommendation is to have an honest conversation with a surgeon with whom you connect.  Everyone's preference is always to use septum if it's there. Rib or ear would be only as necessary. Hope this helps. Good luck!

In my opinion, it is important to use 'best available' cartilage in revision rhinoplasty ... even in cases where per-op evaluation suggests that septal cartilage is potentially available, I stay away from it for 3 reasons: there will not likely be sufficient quantity/quality; I prefer not to compromise existing nasal support; and perhaps most importantly I am very careful to keep the 'inside' and 'outside' of the nose apart.... I don't expect you to fully understand this concept, but basically you want to keep the structural and breathing sides of the nose excluded from one another so as to prevent an infection... going to rib cartilage allows the surgeon to limit the nasal dissection to some degree ... besides, in the right hands a rib graft is not a terribly big dealgood luck

 Much more information is required such as a internal examination of the nose  should be able to approximate how much cartilage is left over from your primary rhinoplasty. Also important to know if you have previous septoplasty. Also important to know how much  Cartilage grafting you had in the primary rhinoplasty, and how much cartilage grafting you need in the secondary rhinoplasty.

I want to disuade you from attempting to remove more septal cartilage since it will be crudy and may compromise your nasal stability. However, we utilize organ donated rib cartilage that can be purchased for only 500$ which is a bargain because it saves operative time of harvesting your own chartilage as well as the pain and suffering with harvesting your own.

Dear NotwhatIhoped, It sounds like you likely have enough septal cartilage for revision surgery. What you may be experiencing with your consulting surgeons is their personal preference. Some surgeons prefer to use rib grafting and others are fine with septal grafting. Best regards, Michael V. Elam, M.D.