What is the Difference Between Costal Rib Grafting and Costal Rib Dicing into Fascia Rhinoplasty? Warp V. Bump?

What is the difference between costal rib grafting and dicing? I've heard some surgeons use a whole block to insert and some surgeons use the same cartilage, but dice it up and put it into fascia? With both procedures does the cartilage reabsorb? Also, when you dice it, does the cartilage cause bumpiness on the bridge years later? With the "blocking" method, does it usually warp later?

Doctor Answers 9

Costal rib grafting versus costal rib dicing

  The primary cartilages used first for dorsal augmentation is nose cartilage. This is simply the best material used to augment the bridge of the nose. Ear cartilage grafting can also be used is a secondary source of cartilage when the nose is been depleted of cartilage. Rib cartilage  is used by some  surgeons for grafting purposes. A whole rib graft can be used, or the rib cartilage can be diced up into small pieces and wrapped with fascia. Each one of the rib grafts do have their own limitations such as warping and  irregularities even in experienced hands.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 146 reviews

Carved rib or diced cartilage

Both are methods used to augment the bridge of the nose. They both have pro's and con's and different indications. The carved rib is usually used when there is significant augmentation needed (greater than 4mm) or when there is a structural deficiency to the nose which requires a structural graft. the diced cartilage is used for non-structural augmentation with  3 mm or less required. 

Andres Bustillo, MD, FACS
Miami Facial Plastic Surgeon
4.9 out of 5 stars 117 reviews

For revision rhinoplasty, both rib grafts and diced cartilage can yield very good results

Both procedures can be very rewarding but both can also have complications. Both can also be used for large or small defects. The primary problem with rib grafts is warping and difficulty carving a precise smooth contour. Diced cartilage wrapped in fascia reduces those risks but can also leave tiny bumps. No procedure or surgeon is infallible. See a few Rhinoplasty  surgeons and decide who you feel will best suit your needs.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 127 reviews

What is the Difference Between Costal Rib Grafting and Costal Rib Dicing into Fascia Rhinoplasty? Warp V. Bump?

    There can be warping with a block of cartilage.  Diced cartilage in fascia should not be lumpy.  Cartilage resorption is variable.  Find a plastic surgeon with ELITE credentials who performs hundreds of rhinoplasties each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 reviews

What is the Difference Between Costal Rib Grafting and Costal Rib Dicing into Fascia Rhinoplasty? Warp V. Bump?

Hi jootyhuynh and thanks for your question.

Diced cartilage + fascia graft is used to augment the dorsum of the nose. The Fascia helps to keep the diced cartilage together and also to give a smooth feel. 

Rib grafts on the other hand are strong structural grafts and can be used for a variety of reasons including dorsal augmentation. Usually when a lot of strong cartilage is needed and the nasal septum ( that is the common source of cartilage) is inadequate.

All the best


Naveen Somia, MBBS, PhD, FRACS
Sydney Plastic Surgeon
5.0 out of 5 stars 74 reviews

Rib cartilage vs diced cartilage

Diced cartilage wrapped in fascia or alloderm is diced small so that lumpiness is unlikely. It is used for small dorsal elevations.  Rib cartilage undiced is better for larger dorsal augmentations.

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

Rib cartilage, diced or solid graft

Both techniques are useful.  Diced cartilage can be useful for adding volume to the nasal dorsum.  It can create a smooth bridge. This technique is useful for miner augmentation of the dorsum  which is often desired in the asian and african american  patient population.  Solid grafts have the advantage rebuilding the bridge and possibly opening the nasal airway with spreader grafts. Solid grafts can provide more significant augmentation to the bridge.  Solid grafts are more useful in my opinion for reconstructive cases or cases that need significant dorsal  augmentation and nasal lengthening.

Philip Solomon, MD, FRCS
Toronto Facial Plastic Surgeon
4.3 out of 5 stars 96 reviews

Costal Cartilage Grafts

Rib or ear cartilage is commonly harvested and used to build up the bridge of the nose depending on how much cartilage is needed.  Diced cartilage does not cause bumpiness on the bridge after healing particularly when it is put in fascia as that creates a smooth covering.  Please consult with a board certified specialist who can assist you in achieving the results you seek.

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Difference Between Rib Grafts and Diced Rib Grafts in Fascia

Rib grafts are obviously harvested from the ribs. These grafts can be placed en bloc or diced into pieces less than a mm in size and then wrapped in fascia before placement. Studies have shown that there is less absorption and warping with the diced cartilage. The diced cartilage is so small that "bumpiness" does not occur.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 39 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.