Revision rhinoplasty is a very complex procedure demanding an intense understanding and appreciation for the correction of the undesired nasal deformity. What makes Miami revision rhinoplasty very complicated is the fact that, as a surgeon, one never knows what lies underneath the skin and soft tissue of the nose. The normal nasal structure—cartilage, and bones—has been altered by the initial surgery.
Nose Cartilage Components
The nose is essentially composed of two pairs of cartilages, those about the middle portion of the nose, the upper lateral cartilages, and those which make up the tip, the lower lateral cartilage. Additionally, the septum of the nose and the nasal bones provide the foundation of structure and support. The septum is composed of both nasal cartilage towards the front of the nose and bone in the deeper aspects. Most, if not all, of these nasal framework components, are altered in some way during a rhinoplasty procedure. The degree and the manner of their alteration are not known by the revision rhinoplasty surgeon beforehand.
Cartilage graft materials whether taken from the nasal septum, ear, or rib are used to provide shape to the nose. Cartilage grafts also provide the added benefit of supporting the structure of the nose. Septal cartilage is the ‘ideal’ cartilage to use for these purposes—it is a strong, thin cartilage. Oftentimes, however, septal cartilage is missing or has been removed during the previous rhinoplasty. To revise a rhinoplasty Miami, grafting material is nearly always needed to correct the underlying deformities.
Given the missing septal cartilage, the only source of cartilage grafting material left available to the surgeon is either from the ear or the rib. Ear cartilage is a great option for revision rhinoplasty Miami when used in specific locations and for certain problems. I opt to use ear cartilage when I encounter the need for grafting material in certain locations within the nose and for specific purposes.
Rib cartilage grafting
It may come as a surprise to most that our ribs are composed of cartilage as they approach the middle of our chest or the sternum. It surprises most patients because of the strength of our rib cages.
Harvesting Rib Cartilage
Harvesting of rib cartilage does not necessarily weaken our strong rib cages. I aim to remove rib cartilage from the 6th and, at times, the 7th rib. The 6th rib cartilage lies approximately directly below the breast crease in women and below the larger chest muscles in men, allowing for a camouflaging of the incision within this crease.
Rib graft procedure from the 6th rib is different than where some other surgeons choose to harvest, as some harvest from ribs lower in the rib cage. An additional benefit of removing cartilage from the 6th rib is that this is not a ‘free-floating’ rib—it has firm bony attachments to the surrounding rib cage and the sternum (chest plate bone at the center of our chests).
Removing a small piece of rib cartilage from the center of this firmly attached rib provides the benefit of reducing discomfort after surgery.
Cartilage grafting discomfort
Discomfort is minimized by limiting the removal of the rib to this site specifically while keeping the surrounding tissue intact. In this same manner, the risk is minimized to the surrounding chest and underlying lungs through this preservation of the tissues underlying and surrounding the rib.
Given a great deal of attention that plays into the harvesting (removal) of the rib cartilage, it is actually what to do next with the rib cartilage which is most intimidating to Miami rhinoplasty surgeons. The difficulty in using a rib (and the reason why most surgeons do not perform rib graft secondary rhinoplasty) lies in the ‘when, how, and where to use the rib.
Donor Rib Cartilage
The use of donor cartilage, such as rib cartilage, can also save a great deal of surgical time during the procedure. It is already prepared for the surgeon and can be quickly transplanted into new areas of the nose. This allows for more precision in creating the desired shape and can help to achieve results much faster than if all cartilage had to be harvested from the patient’s own body. Additionally, because donor rib cartilage is generally stronger than other types of cartilage, it can provide added support and stability to the nose after rhinoplasty.
Rib Cartilage Grafting Risks
The risk of using rib cartilage in the hands of inexperienced surgeons with its use is that rib cartilage tends to warp or change shape and could lead to an awkward appearance of the nose. It is not that surgeons with more experience with rib cartilage somehow magically prevent ribs from warping or changing shape. On the contrary, it is the use of the rib in the proper locations, with proper and advanced rhinoplasty techniques, which greatly reduces the possibility that any changes within the shape of the rib cartilage will create changes in the outward appearance of the nose.
Risk of rejection for Donor Rib Cartilage
Although donor cartilage can provide added support and stability to the nose after rhinoplasty, there is a risk of rejection when utilizing donor tissue. This is because the body may reject foreign tissue if it does not recognize it as its own. To reduce this risk of Miami rhinoplasty revision, surgeons should always source high-quality donor cartilage from reputable suppliers and ensure that all sterilization processes have been followed correctly.
Patients need to be aware that this type of surgery carries a higher risk than traditional rhinoplasty techniques as any changes in the shape of the rib cartilage could potentially create visible changes in their nasal appearance.
In addition to the use of donor rib cartilage, some surgeons opt to use artificial materials. Artificial materials may be used to augment or replace cartilage grafts and, while it does provide an additional option, it also carries with it additional risks. It includes the risk of infection and other problems that could affect the surgical outcome. Artificial implants may need more maintenance than natural grafts, which can be time-consuming and costly.
When used properly, rib cartilage provides is an effective option, the long-term outcome is a nice aesthetic shape of the revised nose with a natural appearance.
Talk with a Rhinoplasty Expert in Miami
If you’re considering rib graft rhinoplasty to enhance your facial features, be sure to consult with a board-certified facial plastic surgeon such as Dr. Bared. He has extensive experience in performing primary rhinoplasty and revision rhinoplasty surgeries and can provide you with the individualized care and attention that you need. To learn more about rib graft rhinoplasty or to schedule your appointment, contact us today!