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 Costal Cartilage Rhinoplasty
Rhinoplasty surgeons generally prefer to maintain structure within the nasal skin envelope.
Often to maintain or create structure cartilage harvested from the patients own body is required. Septal cartilage from the middle wall of the nose is most desirable. Unfortunately often there is insufficient septal cartilage to create adequate contour or structural support. When septal cartilage is not sufficient, alternative grafting materials are demanded.
When the septal cartilage is not adequate, ear cartilage can be used. Unfortunately, ear cartilage is relatively brittle and may not be sculptured to required shapes. After extensive experience with many grafting materials I now rely on costal cartilage from the ribs. Not only does it allow me to perform a rhinoplasty to my satisfaction, but I have found costal cartilage to be the strongest and reliable source of donor material. We also have a very low complication rate harvesting and using costal cartilage.
Costal cartilage for augmentation rhinoplasty in Asian patients is competing with preformed silicone implants for nasal re-contouring
Typically I use the costal cartilage from a suitable shaped rib from the right side of the chest through a small incision (approximately 3-5 cm long).
We use a technique of rib cartilage harvest that minimizes the postoperative pain. I have found that it takes less recovery and is less painful for patients to take a costal cartilage graft than to take cartilage from the ears.
It is my opinion that a large number of rhinoplasties fail because of a lifelong scar contracture affect that tends to contract and collapse the nose. Many patients who have undergone rhinoplasty had a good or reasonable outcome initially that worsened over time. Most patients whom I see for secondary rhinoplasty state that their nose was improved at first but then got worse and worse over many years. The reason is that the previous operation weakened the nose, setting it up for collapse.
In addition over the patients entire lifetime after surgery, the nose will continue to heal and change. Most of these changes tend to present as narrowing or pinching. For this reason, placing strong cartilage grafts to resist these forces will provide the best chance for a good long-term outcome.
Additionally, suction effect as a patient breathes may contributes to collapse of the lateral wall and middle segment (middle nasal vault) of the nose.
To help prevent graft visibility and deformity, I often use the perichondrium that covers the rib cartilage to make the skin thicker and intentionally create extra swelling. Although this tends to make the nose swollen longer right after surgery, perichondrium helps to provide a better long term outcome.
Costal cartilage can bend or warp if not processed properly, so I use special techniques to prepare the costal cartilage that significantly decrease the chances of warping or bending.
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