Is it worth getting a Revision Rhinoplasty using a rib graft? Will it make my nose bigger? I have very thick skin.

Question

After my 2nd surgery my nose was shortened and the definition was noticeable for the first 4 months, I also had steroid injections. My surgeon who did my primary and revision wants to use rib graft to make the shortening noticeable. It's thick skin hanging at the columella, when I push it up the skin sticks to the cartilage tip and looks shortened. I do not want my nose to be bigger & my surgeon has said it would not be. Is there a chance of my nose appearing larger when using rib graft?

Alejandro Nogueira, MD · Answer

I don't recommend rib grafting for your nose. Your have a problem of:-long tip-too low upper part of the bridge (from radix to half) needing a cartilage graft as onlay-too high lower part of the bridge needing to be shaven down accordingly to the upper half and the slightly newly shortened tipIt is a very difficult case, of high precision, you need a very very good surgeon. Beware of snake charmers, you need a guy who really understand the disbalance of your dorsum and how to handle it.Eventually you might need temporalis fascia graft as blanket to cover your dorsum made of different fragments.

Thomas A. Mustoe, MD, FACS · Answer

You liked your nose at 6 months after kenalog injections to shrink soft tissue. Therefore the cartilage framework is not the issue.  Adding or substituting cartilage unlikely to help.  On the other hand a revision with removal of scar tissue combined with more aggressive monthly kenalog injections may help considerably.  I have.done this successfully in a number of patients.

Zoran Potparic, MD · Answer

We usually use rib grafts when nasal (septal) or ear cartilage is depleted or for large augmentation of dorsum. Based on your photos it doesn't appear that you need such an augmentation? Without a detailed clinical exam it would not be possible to give you good advice. You may consider a second opinion consult by a plastic or ENT surgeon with good reputation in rhinoplasty before committing yourself to another surgery. Good luck.

William Portuese, MD · Answer

Placing a rib graft in the nose will make the nose bigger, and harder  since  rib grafting adds bulk to the nose.  It is very important to determine where the rib graft is going to be placed and for what reasons. In our practice, we recommend using nasal cartilage first, before using rib cartilage  when cartilage grafting techniques in the nose are required.

Dennis Barek, MD (retired) · Answer

Rib  graft can be a cartilage graft and used when the nose is depleted of septal cartilage and the ear is not appropriate. Rib cartilage can be carved to fit the defect  and wont add bulk. Warping of the cartilage is one of the risks you have to consider.

Is it worth getting a Revision Rhinoplasty using a rib graft? Will it make my nose bigger? I have very thick skin.

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Is it worth getting a Revision Rhinoplasty using a rib graft? Will it make my nose bigger? I have very thick skin.

Answers (5)

Answer: Revision rhinoplasty with a rib graft

Answer: Revision rhinoplasty with a rib graft

Answer: Rib graft

Answer: Rib graft

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Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.