Revision rhinoplasty- Replace entire septum with rib cartilage?

Dear crystalangel~

Sometimes the septum can remain deviated after multiple surgeries. It depends what was done during the prior surgeries, how you healed, and how bad the deviation was.

It’s possible that your surgeon is recommending an “extracorporeal” septoplasty, which is essentially a reconstruction of the entire septum. The deviated portions are removed, reshaped, reassembled, and then replaced within your septum. Your surgeon may plan to use rib cartilage to reconstruct the septum if there is not enough cartilage present.

Rib cartilage is usually harvested without bone and does not resorb significantly over time. It is frequently used during septorhinoplasty for different types of grafts, including septal grafts such as “septal extension grafts". It is secured between the septal mucosa in both sides of your nose, and once it heals you will not notice any difference between it and septal cartilage. Although it would not be common to harvest rib just for septal surgery, it may be that you also you require other types of grafting (for example, if you also have nasal valve collapse).

If may be helpful for you to seek additional consultations with other surgeons before proceeding with surgery.

Best wishes,
Amy Hsu

I do not know of any one who would routinely replace the septum with rib cartilage. If the entire septum is removed and replaced it is performed extracorporeal and not performed commonly in most cases.

We have never heard of removing the entire septum and replacing it with rib cartilage. Rib cartilage can be used for grafting purposes during the rhinoplasty procedure, which is completely separate than a septoplasty procedure. For more information and diagrams showing the difference between a septoplasty and a rhinoplasty, please see the video link below

Persistant septal deviation after 3 septoplasty procedures is extremely uncommon.  After the initial septoplasty, each successive procedure is progressively more difficult and potential complications multiply.  It is unlikely that your surgeon is recommending removal of the "entire" septum.  Complete removal often results in collapse of the nose.  Grafting any material (including rib) to the septum is as uncommon as your problem.  As always, it is important to personally consult with a board-certified Plastic Surgeon or Otolaryngologist