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Anthony Bared: Hi, my name is Anthony Bared. I'm a facial plastic surgeon in Miami Florida and I'm here with a patient who one week ago underwent a rib revision rhinoplasty and I wanted to share the patient’s experience and her postoperative course, obviously this being very early in the first week. I just want to show the patient’s preoperative findings. Her main issue was the patient had had two previous surgeries and three previous traumas. If you can just focus in here, the frontal view was nothing too alarming. In fact, it was very deceptive in this patient’s findings under the skin. You just see a lot of asymmetries in the nostrils, but her biggest issues were her profile view.

As you can see, she had a droopy tip as well as a hidden columella. These were the cosmetic findings, but the most challenging of which was her breathing issues. Because of the previous surgeries, as you can see here on the base view which is very informative. She had extreme narrowing of her nasal valve on the right side and complete obstruction of the patient’s left side. Intraoperatively it was a very complicated case with a lot of scar tissue and grafts that were noted. Importantly there were no lower lateral cartilages, which on the cartilages is that make up the tip so those had to be completely reconstructed.

For this purpose and the fact that the patient had had previous surgeries as well as ear cartilage use in the past, rib cartilage was used and this was harvested from her right chest wall. I used approximately the 6th or 7th rib cartilage depending on the patient’s anatomy. So I just wanted to share with the patient. She’s with us today of her experience. If you just could explain to patients the postoperative period with any fears that you might had and so forth and your experiences for the last week at least. I know it’s only been one week.

Female: My worst fear was that I am going to bring worst for the inner scars and that I was going to have a huge scar on my breast, but I started breathing better by day two and even better by now.

Anthony Bared: As far as the chest wall incision and so forth?

Female: You can’t even see it, barely and it’s been a week. I’m happy.

Anthony Bared: I purposely performed the harvest of her cartilage from the 6th rib which is higher up in the chest and in women; it’s very well hidden because it’s actually hidden in the crease below the breast. It’s called the inframammary crease. So therefore with the breast overlying it, it’s very, very well camouflage in that area and so for this reason, I used that cartilage and not the lower cartilage, the free floating cartilage such as the 10th rib and so forth which is often used with incisions on the right chest wall.

So as you can see, she’s very swollen on the frontal view and that will obviously go down over time. It’s only been one week and the cast was initially removed but importantly you’ll see the changes on the profile view which are immediately evident. So thank you very much. My name is Anthony Bared. I’m a facial plastic surgeon in Miami, Florida.

Revision Rhinoplasty WIth Rib Graft: 1 Week Results

Dr. Anthony Bared is with a female patient (1 week post-op) on whom he performed a complex rib revision rhinoplasty to help improve her complications from two previous performed surgeries and multiple traumas.