Nasal grafts or nose cartilage grafting is a common procedure used in augmentation and revision rhinoplasties around the world. The basic procedure involves taking cartilage from one area of the body, shaping it, and placing it in the nose to give the nasal structure more strength and reinforcement. It also has a cosmetic element to it, especially in Asian rhinoplasties. Rib cartilage rhinoplasty has emerged as the gold standard for nasal reconstruction.
The rib cartilage grafts are used in many cases especially when there is a need of
- Nasal bridge augmentation: in cases of patients who have a lesser defined nasal bridge. This makes the nose look flatter. Loss of nasal bridge height is mainly because genetics or a previous injury. Cartilage grafting for the bridge gives the nose a better shape and even helps resolves some breathing issues.
- Tip refinement: Patients with boxy or droopy tip benefit from rib cartilage rhinoplasty greatly. This is especially true for people who have a thick skin or a weak cartilage support in the nose. Rib cartilage is shaped to create a more aesthetically pleasing nose tip.
- Correcting nasal asymmetry: Cartilages are also used to correct nose crookedness because of genetics or accidents. By using the cartilage graft the rhinoplasty surgeon can create a more balanced and harmonious appearance of the nose. It is also used to straighten the nose.
- Resolving functional issues with the nose: A collapsed or reduced septum can lead to severe breathing issues in a patient. Rib cartilage grafting in rhinoplasty is used to strengthen and rebuild the septum and prevent any future collapse in the nasals structure during breathing.
- Revision rhinoplasty: Previous rhinoplasties often leave the internal structures of nose weak. Cartilage rhinoplasty is used to correct deformities and asymmetries that are caused because of primary rhinoplasties or no correct in the initial procedure. This has both cosmetic and functional benefits.
Rib cartilage rhinoplasty gives a nose surgeon a versatility to address a wide range of cosmetic and functional concerns. Experienced plastic surgeon are the best people to go to understand whether a cartilage grafting will suit your specific needs and goals. The right selection of graft and use of expert technique can help one achieve the beautiful and functional nose that they desire.
Which Types Of Rhinoplasties Use Rib Cartilage Grafting?
Rib cartilage rhinoplasty is the gold standard for nasal reconstruction because of its nature and availability and it is used in many types of nasal corrections including
- Saddle nose deformity
- Crooked nose rhinoplasty
- Tip plasty including pinched and boxy nose corrections
- Septoplasty and Septorhinoplasty
- Collapsed nostril correction
What Are the Benefits of Rib Cartilage Rhinoplasty
- Improved and stable structural support
- Improvement in breathing
- Increased precision and control
- Reduced risk of complications as compared to silicon or alloplastic grafts
- Most natural looking results as the graft is taken from the patient’s body and hence, they blend seamlessly
- Long lasting and stable results
Advantages of Using Rib Cartilage for Nasal Reconstruction
Apart from rib cartilage the other types of cartilages used for rhinoplasty are nose cartilage and ear cartilage. however, the nose and ear cartilages can only be used for minor corrections and are often not very stable. The rib cartilage on the other hand is
- Very resilient and can easily withstand the expansion and deflation the happens when we breathe.
- Available in plenty and can be used in cases when large amount of tissue is need or the surgeon needs to perform multiple grafts to reconstruct the nose.
Thus, the rib cartilage rhinoplasty is very suitable to transforming the broad or wide nostrils to a more desirable oval shaped. The strength of rib cartilage is also desirable in lengthening the short nose and adding a stable tip projection.
How Is Rib Cartilage Rhinoplasty Done?
It is a simple and safe procedure and the patient can go home the same day unless otherwise necessary. Two rhinoplasty teams work simultaneously in this procedure. Here are the steps for the procedure
- Once the surgeon has determined the need for use of rib cartilage for rhinoplasty they will prepare for the surgery
- The harvesting is done making a small incision in the chest of the patient where the rib is to harvested. In case of female patients, the incision is usually done under the breasts to hide the scarring. If the patient desires to have a breast augmentation procedure in the future the expert rhinoplasty surgeons make the incision for rib cartilage rhinoplasty on the approximate site of the anticipated breast fold.
- Usually, the grafts are taken from the 5th to 8th ribs but when the graft needed is straighter than the surgeon might prefer the free-floating 11th and 12th ribs as they don’t require much carving and have lesser warping tendency.
- Since rib cartilage is susceptible to warping in 15-60 minutes of harvesting, the graft is collected through an open procedure.
- The graft is quicky modelled for the recipient site as the other team prepares the site.
- The surgeon will then place the graft in the desired position and close any sutures that were made.
The cartilage is removed in such a way that the tissue is intact to minimize discomfort. Rib cartilage rhinoplasty is a complex procedure and needs great deal of expertise on the part of the rhinoplasty surgeon.
Risks of Rib Cartilage Rhinoplasty
The risks are minimal if the surgery is done by an expert rhinoplasty surgeon. When done by the inexperience surgeon, it runs a risk of warp or change in the shape of cartilage leading to collapse in of the nasal structure. Advanced rhinoplasty techniques and proper placement of the graft reduces the risk of future complications. Still some drawbacks of rib cartilage rhinoplasty are
- Invasiveness and Complexity: Rib cartilage rhinoplasty is a more invasive and complex procedure compared to other types of rhinoplasties. It involves an additional incision on the chest to harvest rib cartilage, which can result in more pain, a longer recovery period, and a higher risk of complications.
- Scarring: The incision made on the chest to harvest the rib cartilage can result in a noticeable scar. While efforts are made to place the incision in a discreet location, scarring can still be a concern for some patients.
- Pain and Discomfort: Recovery from rib cartilage rhinoplasty can be more painful and uncomfortable compared to other types of rhinoplasties. The chest area where the cartilage is harvested may experience pain and discomfort for an extended period.
- Longer Recovery Time: Due to the invasiveness of the procedure and the fact that two surgical sites are involved (nose and chest), the recovery time for rib cartilage rhinoplasty is generally longer than for other rhinoplasty techniques.
- Potential Complications: Rib cartilage rhinoplasty carries a higher risk of complications compared to less invasive techniques. Potential complications include infection, hematoma (collection of blood under the skin), seroma (accumulation of fluid), and delayed wound healing.
- Cartilage Availability and Quality: The amount and quality of rib cartilage available may vary among individuals. Some patients may not have sufficient cartilage in their ribcage, making this technique unsuitable for them.
- Warping and Shifting: Rib cartilage is a living tissue, and over time, it can change shape, warp, or shift. This can lead to changes in the appearance of the nose and require additional surgical interventions to correct.
- Donor Site Morbidity: Harvesting rib cartilage can potentially cause complications at the donor site on the ribcage, including pain, asymmetry, and the risk of damage to nearby structures.
- Additional Surgical Time: The process of harvesting rib cartilage adds additional surgical time to the rhinoplasty procedure, which can increase the overall duration of the surgery and the time the patient spends under anaesthesia.
- Cost: Rib cartilage rhinoplasty is generally more expensive than other rhinoplasty techniques due to its complexity and the additional surgical steps involved.
It’s important to note that the decision to undergo rib cartilage rhinoplasty should be made in consultation with a skilled and experienced plastic surgeon. They can provide you with personalized advice based on your individual anatomy and goals, as well as discuss the potential benefits and disadvantages of this technique in your specific case.