Dr. Bared explaining the use of Rib Cartilage in Revision Rhinoplasty
Dr. Bared was recently invited as an expert speaker at the 31st Annual American Academy of Cosmetic Surgery meeting in New Orleans. At the meeting Dr. Bared spoke about the use of rib cartilage in revision rhinoplasty. Dr. Bared first reviewed with the other surgeons in the audience the indication, the advantages and the disadvantages of using rib cartilage. He then explained certain surgical techniques which can be employed to safely and effectively use rib cartilage in revision rhinoplasty.
Indications/ Advantages/ Disadvantages
The indication for the use of rib cartilage in rhinoplasty varies for each surgeon. Dr. Bared explained to the audience what propels him to use rib cartilage in revision rhinoplasty. Rib cartilage is mostly used in revision rhinoplasty surgery when the patient does not have septal cartilage. Septal cartilage is the ideal cartilage to use in rhinoplasty as it can provide thin, strong pieces of support to the structure of the nose. However, many times in revision rhinoplasty surgery septal cartilage is not present or sufficient to address the deformities of the nose. In cases where the nose is deviated, pinched, or overly narrowed from previous rhinoplasty surgery rib cartilage can then be used as a source for cartilage grafting. Rib cartilage has much of the inherent properties of septal cartilage in that it can be shaved to very thin pieces yet still retain its strength. Another great advantage of rib cartilage is that from a small segment of cartilage there is an abundance of usable pieces which can be used for grafts. This is in contrast to ear cartilage. In a sense, ear cartilage taken from both ears does not equal the amount of usable cartilage that can be obtained from a small segment of rib cartilage. However, one of the disadvantages of rib cartilage is the learning curve needed as a surgeon to be able to use it properly. Rib cartilage is not used by surgeons who perform revision rhinoplasty sparingly but rather surgeons need to be adept at how to use the cartilage. The second disadvantage of rib cartilage is that it requires an incision in the chest. With Dr. Bared’s technique, he harvests the cartilage from the 6th or 7th rib by which the incision can be concealed within the crease underneath the female patient’s breast or under the chest muscle in males.
Dr. Bared explained to the audience his surgical technique in how to best optimize and use rib cartilage in revision rhinoplasty surgery. Dr. Bared first explained his technique for the harvesting or removal of the cartilage. He explained how to best employ the technique to minimize risks associated with rib graft harvesting such as injury to the lining of the lungs resulting in what is called a pneumothorax. The inexperienced surgeon may find the proper use of rib cartilage to be daunting in that they are leery of the cartilage warping or bending after the surgery. Dr. Bared explained that if the cartilage is carved in a certain manner and used in a certain manner the risk of cartilage warping after surgery can be minimized. He explained his technique for carving the cartilage and using the cartilage pieces in a certain manner to help greatly decrease the risk if warping. Dr. Bared explained that the younger the patient, the more he expects for the cartilage to bend as younger patients have less calcium deposits in the cartilage. Being that this is expected in the younger patient, certain maneuvers can be employed to essentially take advantage of this property of the cartilage. In sum, with the proper indications and with the use of certain surgical techniques, rib cartilage can be a very effective means of helping to correct deformities present in revision rhinoplasty.