Nasal Reconstruction with Rib (Costal) Graft
3 December 2019 onur
Even the name is scary.
It evokes memories from a steakhouse rather than Plastic Surgery.
The anterior parts of human ribs are cartilaginous. For plastic surgeons, these cartilages are gold. You can think of it like the cartilage bank of the body.
From this cartilage bank, for instance, we can make ears for children born without ears, and noses for people who have lost their nose to tumor or trauma.
Rhinoplasty is assuming a more sparing outlook every year.
We try not to reduce the support tissue (bone/cartilage) in the nose to the extent possible.
We preserve cartilage and bone volume.
Beyond the aesthetically-necessary measure, we do not reduce the nose structurally just because the patient likes a button nose. For instance, in the past, rhinoplasty equaled nose reduction. Today, we take care to reduce some noses, enlarge some others and spare up to 90% of the original volume in most noses. We do not shape cartilage in a closed manner and without seeing it, so the possibility of accidentally removing more cartilage than necessary is eliminated. We correct the deviations of the septal cartilage, which separates the nose into two airways and also gives nose the midline structural support, and shape it inside the nose, not by cutting the cartilage.
After the new-generation rhinoplasty operations performed in line with modern principles, the probability of a deformity requiring correction with a rib graft is extremely low. There is a group of patients in whom the central (septal) cartilage of the nose is congenitally underdeveloped. In this group, it may be necessary to support the nose with ribs, even if the patient has not had any previous surgery. In fact, if you do not use a rib graft in the first operation in this patient group, you will eventually need to use it in a revision surgery. However, patients with congenital septal cartilage deficiency represent less than 5% of the Turkish population. We are lucky because in African/Asian societies, this rate can rise up to 50-60%.
In our society, the most common reason for revision surgeries requiring rib grafting is previous surgeries. If you have had rhinoplasty and your nose has lost its structural support, softened or reduced, it means there is no other option but to reconstruct your nose.
The rib graft is usually harvested from a 2-3 cm incision under the breast in women. The incision remains in the inframammary fold and does not catch attention. It’s the same incision we do when placing breast implants but just a smaller one. In men, we prefer to harvest rib graft from rather lower parts of the body. There is a slight pain in the first 2 days where we harvest the ribs but it disappears in a few days with routine painkillers.
We harvest the rib graft in the same surgical session when we do the nasal revision. Reopening noses damaged enough to require a rib graft is a challenge in itself and takes time. Harvesting the rib graft, closing the harvest area, shaping the graft on the table, reconstructing the nose with that graft, and closing the nose are separate surgical stages. Typically, revision surgeries with rib grafts thus take a long time. The price range is 2-3 times higher than a normal surgery. The number of surgeons performing revision surgery is less than one thirtieth of the number of surgeons performing primary surgery.
As a basic principle, if your nose is damaged to an extent requiring a rib graft after an operation, it is extremely unlikely that the doctor who performed your first operation will be able to correct your nose in a revision surgery immediately after the primary operation.
Revisions with rib grafts cannot create a perfect nose. It will almost always be necessary to perform minor complementary procedures under local anesthesia in the 1-2 year period following nasal reconstruction.
I use rib grafts very often.
Before undergoing a secondary surgery, we get consent from all patients that we may need to harvest rib cartilage. I harvest it when needed. It’s not a big decision for me.
The worst case scenario is one in which the surgeon opens the nose in secondary rhinoplasty, observes a tissue deficiency, and then tries to save the day with maneuvers and touches here and there, without being able to eliminate the deficiency. You lose your precious chance of revision. Therefore, it is imperative that all options are on the table in revision surgeries.
Please feel free to contact us for detailed information on nasal reconstruction surgery with rib grafting.
Take good care…
… of yourself and your beauty.