Had Two Consultations for Revision Rhinoplasty, One Suggested Ear Cartilage, the Other Rib, Which is Best?

Doctor Answers 9

Ear vs Rib Cartilage for Rhinoplasty Rervision

There is no single right answer to your question. Every surgeon has their own preferences. The choice between these different sources of cartilage does depend on quantity of available donor tissue and what needs to be done in your revision. Whenever possible I prefer septal and/or ear cartilage because it is more difficult to harvest from the ribs, the patient has less post-operative pain, and avoids a scar on the chest.

Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Cartilage for Revision Rhinoplasty

Revision rhinoplasty is a very personal and individualized operation. The needs of each patient are unique, and you must consult with a surgeon who is familiar with the nuances of rhinoplasty surgery. Using ear cartilage for secondary surgery is common, and if carved and placed properly can be very helpful. In some circumstances using septal cartilage may be preferred, but it is not always available if a deviated septum operation was performed at the first procedure. If ear and/or septal cartilage is not available, then rib cartilage may be necessary. These questions should be discussed and sorted out prior to any revision procedure. It is best to have the patient and surgeon agree on a plan before any intervention.

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

Depends on the use


Septal cartilage, ear cartilage and costal cartilage (rib) have very different characteristics and should be used for different purposes.  

The ideal cartilage for rhinoplasty and revision rhinoplasty is septal cartilage but the availability of it may not allow its use if the previous surgeon has already removed and used it or if the cartilage is small and inadequate.

Ear cartilage is easy to harvest but it is thick and floppy and not ideal for most uses but most plastic surgeons feel very comfortable harvesting and using it.  It is not ideal unless a composite graft is needed which has skin attached to the cartilage and used in the nostril area.

Rib cartilage is nice because it is strong and abundant but harvesting it takes more skill and carving it properly takes even more skill

Shervin Naderi, MD, FACS
Washington DC Facial Plastic Surgeon
5.0 out of 5 stars 105 reviews

Cartilage sources

I think it depends on the surgeon's individual preference.

Rib cartilage is relatively stiff and is good for any structural work - supporting a nose, rebuilding overly narrowed noses, etc.

Ear cartilage is quite a bit softer and more elastic, so I don't think it has much use as a structural support, however its natural curvature makes it good for onlay grafts where one is trying to change contours.

Douglas J. Kibblewhite, MD
Vancouver Facial Plastic Surgeon

Revision Rhinoplasty: Ear or Rib Cartilage?

I agree with previous posters regarding Surgeon preference. Hands down, the nasal septum is the best source of cartilage for Rhinoplasty grafting.  However, there are several factors associated with each source of cartilage which must be considered.  The availability of quality conchal cartilage is limited.  It tends to fracture more easily and has a natural curvature which is not suitable for certain types of cartilage grafting (spreader grafts, caudal septal extension grafts, columellar struts, etc.).  Rib ossifies over time and when harvested in a mature adult, is often closer to bone. Secondly,  the harvesting process carries with it a small but real risk of pneumothorax (collapsed lung), making a postoperative chest X-ray a consideration.  Lastly, conchal cartilage can warp over time, compromising the long term aesthetic result.  Your Surgeon should weigh these factors, and based on the anatomical challenges present, will weight the risks and benefits of the grafting source.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 93 reviews

Nasal cartilage is always best for rhinoplasty

Nasal cartilage is always the best source for reconstructive and revision rhinoplasty.  If the nose has been cartilage depleted, the next best type of cartilage is ear cartilage.  Rib cartilage is hard and tends to warp in the healing process, resulting in a nose that feels unnatural and wood-like.  It also requires taking a chunk of rib out from the rib cage and the risks associated of doing so.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Is ear or rib cartilage better for revision rhinoplasty

Ear and rib cartilage are both very good sources of cartilage to use during rhinoplasty and each has its benefits and role in nose surgery.

I don't think that it is correct to say that one is better than the other, but rather it depends on what needs to be done. Ear cartilage isn't as strong as rib cartilage, but it does have a natural curve which can be useful. Rib cartilage is available in a larger supply, but it does take an experienced surgeon who knows how to carve it properly.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 21 reviews

Ear verse rib cartilage graft

There are 3 places to obtain cartilage, the nose, ear and rib. Each cartilage has different properties and therefore are valuable for different issues. The surgical principle is replace like tissue with like tissue. Sometimes it's possible, usually it's not. Septal cartilage has the advantage of being in the same surgical field. Also it's stiff, easily sclupted and the closest equivalent to the other nasal cartilages. It's usually not available. Auricular cartilage carries little additional surgical risk and has a natural bend making it often suitable to replace lower lateral cartilage. It cracks and crumbles easily, is difficult to sculped, leaves a subtle donor defect and if a straight piece is needed, is usually thicker than ideal. Costal cartilage is plentiful, stiff, and easily sculped. However it can warp, requires more surgical time, has risks associated with the harvesting, and leaves a subtle donor defect. The question needed to be asked of your surgeons, is why is he recommending his choice.

Oakley Smith, MD, FRCSC
Toronto Facial Plastic Surgeon
5.0 out of 5 stars 89 reviews

Had Two Consultations for Revision Rhinoplasty, One Suggested Ear Cartilage, the Other Rib, Which is Best?

 IMO it's the nature of plastic and cosmetic surgery, in general and Rhinoplasty specifically to have different opinions about what needs to be done aesthetically and how best to accomplish that goal.  The main and most imporatnt issue IMO is that the plastic and cosmetic surgeon understands and follows the proper aesthetics of facial (and in this case nasal) beauty for the creation of a naturally, more attractive nose and face.  

 The technical aspects of how that aesthetic vision is achieved is secondary.  I have performed Rhinoplasty and revision Rhinoplasty for well over 22 years and IMHO, rib cartilage/bone and ear cartilage folded for use on the nasal dorsum both dissolve unevenly over time and as such I won't use either.

 For building up the nasal bridge, I use a straight silastic dorsal implant because septal cartilage typically is too short to cover the distance of the entire nasal bridge.  For nasal tips, I prefer using conchal ear cartilage eart graft.  Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

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