How to fix warping post surgery from rib cartilage rhinoplasty?

Question

If warping of the rib cartilage occurs post surgery resulting in the nose to look disfigured what can be done to fix this

Christopher Chui, MBBS, MRCS Ed, MMed · Answer

That's a good question.
If warping of the rib cartilage does occur after rhinoplasty, there is no easy way to get it straight again. Depending on how bad the warping is, you may need to revision rhinoplasty. In order to avoid the problem of warping, a lot of surgeons are using diced cartilage in fascia (DCF). This will never warp, however it may not be able to give you as strong an augmentation as a rib graft. 
The other option is to use a silicone implant for your dorsum.
My preference is to use DCF,  especially since you have already harvested your rib. The rib that is warped can be removed, diced, wrapped in fascia then placed back to augment the dorsum of your nose.

Terence Goh, MBBS, MRCS(Ed), FAMS (Plast Surg) · Answer

Dear leeww,
Thank you for your question. Warping of the rib cartilage can happen and if its mild it may be camouflaged with fillers,  otherwise a revision rhinoplasty may be required to address the problem. There are techniques to reduce the risk of warping when using rib cartilage. One of the technique that I routinely use for total autologous dorsal augmentation for Asian Rhinoplasty is to use diced cartilage  wrapped in deep temporal fascia (DC+DTF) for augmentation of the nasal dorsum. The advantages of using diced cartilage is that it is an efficient use of cartilage hence minimising multiple donor sites. In your case, as you already have a rib cartilage, we can diced that up and wrap it with the DTF. The DC+DTF construct will also not warp. As it is your own tissue, it will be a permanent solution unlike silicone implants which have risk of extrusion and migration. I hope this answers your questions. 
All the best and have a great day!
Dr. Terence Goh
MBBS (S'pore), MRCS (Edinburgh), MMed (S'pore)Fellow, Academy of Medicine, Singapore (Plastic Surgery)President, Singapore Association of Plastic Surgeons (SAPS)International Member, American Society of Plastic Surgeons (ASPS)

How to fix warping post surgery from rib cartilage rhinoplasty?

Answers (2)

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