Rib Rhinoplasty – Costal cartilage grafting
What is costal cartilage grafting?
Costal cartilage grafting is the harvest of cartilage from the cartilaginous portion of the rib. The rib is harvested through an incision along the chest wall to remove the cartilage portion of the rib, leaving behind the bony portion of the rib. Typically the fifth or sixth rib are used for rhinoplasty (outlined in pink) due to their shape and configuration.
What are the risks of costal cartilage grafting?
The major risk of costal cartilage grafting is pneumothorax, a release of air from the lungs. This is a major consideration and a surgeon harvesting the costal cartilage should have experience obtaining costal cartilage. Fortunately, I have not had this happen in my career in well over 50 cases.
Another risk is cartilage warping. Over time, costal cartilage can change shape and warp. Carving costal cartilage is very different from cartilage grafting anywhere else. The techniques used to carve it are distinct. This is probably the main factor why very few surgeons use costal cartilage.I have looked at cartilage warping in a few studies looking at different techniques to minimize it.
I am 55 years old and have had five rhinoplastys including both ears. I live in Anartica, can you tell me if my rib can be used?
As we age, the cartilage portion of the rib cage becomes calcified and eventually actually turns to bone. This process is typically complete at age 55, but I operated on patients well over fifty who have had substantial cartilage remaining in their ribs. However, I have also seen patients who are 40 years old and have not had any cartilage remaining in their rib cage.
If there is costal cartilage available in a patient over forty, typically the cartilage is calcified or harder. While this is harder to carve, it often means that the cartilage will warp less INTRAOPERATIVELY.
In the office, in select patients, I can inject a small amount of local anesthetic and actually determine whether or not your ribs are calcified in the office.
What are the advances of costal cartilage grafting?
The last few years costal cartilage grafting techniques have evolved for a better understanding of warping. Surgeons have a better understanding of camoflauge techniques.
Previously, grafts used for augmentation were readily visible.
There is less overaugmentation in patients along the bridge. It is much easier to place a graft all the way to the root of the nose. Unfortunately, many patients look artificial and overly augmented. Placing the graft and a lower position is much more technically demanding, however, it can yield much better aesthetic results.
Which rib do you use and why?
The incision is typically over the 6th rib. However, either the 5th or 6th rib are most commonly used. The 5th rib has the advantage of being straighter and not really connected to any of the other ribs. The disadvantage is it tends to be smaller. The 6th rib tends to be longer but more curved than the 5th rib. In addition, it tends to connect to other ribs.
“The nose should fit the face”
A strong jawline would suggest a stronger nose.
