Revision rhinoplasty is the most challenging facial plastic procedure. Its challenge lies in the unknown. Although we can ‘see’ what issues need to be addressed to make an improvement to the nose, we do not know what lies underneath the skin—the anatomy is unknown. It is for this reason that the surgeon needs to be ‘well-equipped’ with techniques and material to be able to make the necessary improvements. Dr. Bared is highly versed in the most modern techniques in revision rhinoplasty. If warranted by the complexity of the case, Dr. Bared utilizes your rib cartilage as grafting material. Patients may be hesitant to have a rib cartilage graft for various reasons as the thought of an incision in the chest concerns most patients. However, Dr. Bared addresses each of your concerns during the consultation. He has utilizes very specific techniques to maximize the outcome. Some of the concerns patients have are the following: Scar—a small, approximately 3-4 cm incision is used. For women the incision is hidden within or slightly below their right breast crease.
Chest Incision Site
1 week post-op chest wall incision.
Incision placement in the right chest wall underneath the patient’s right breast.
Incision placed within or approximating the crease of the breast.
Pain—the use of rib cartilage is surprisingly not any more painful than when an ear graft is used. Ears are very sensitive, having a lot of sensory nerves. Dr. Bared utilizes a small segment of the 6th or 7th rib and he retains the surrounding attachments to the ribs. By maintaining these attachments, patient’s discomfort after surgery can be limited. In fact, the recovery period after a rib cartilage rhinoplasty is not longer than a normal rhinoplasty. With both procedures you can return to work in one week and to regular exercise in six weeks. Noses are left ‘big’—Dr. Bared utilizes detailed measurements intra-operatively which allow him to accurately compare the nose both before and during surgery. After grafts are placed the nose is measured again in various areas to ensure that it is not wider than it was before surgery. Cartilage ‘warps’—this is a known phenomenon where cartilage may change in shape with time. Dr. Bared greatly minimizes this risk through the techniques which he employs when using rib graft. Rib cartilage, like any other grafting material, needs to be utilized appropriately to achieve successful, long-lasting results.
Dr. Anthony Bared interviews a female patient who he performed a rib revision rhinoplasty to improve the nose from previous procedures she had in the past.
Rib cartilage confers many advantages for the patient seeking a revision rhinoplasty. For one, it is your body’s own material. No foreign grafts are introduced into the nose. When a patient has a revision rhinoplasty, the blood supply into the nose is more limited than in a patient who has not had a previous procedure. This makes one more susceptible to risks like infections. Since rib cartilage is grafting material from one’s own body it incorporates naturally into the nose. Secondly, it is a very sturdy graft material that can be shaped into very thin slices, retaining its strength and durability. Ear cartilage, for one, does not have this intrinsic strength. Ideally cartilage from the septum is used as grafting material, but septal cartilage is often not available in revision cases. Its strength makes rib cartilage a very suitable graft material for complex revision cases. Lastly, rib cartilage provides a sufficient amount of grafting material often needed in revision cases—material from two ear grafts does not provide the same quantity of graft material.