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key to rib cartilage use in rhinoplasty

I had the joy to guest edit a special issue ' The key to costal cartilage in rhinoplasty' in journal 'Plastic and Aesthetic Research'. This special issue covers all issues of rib cartilage use in rhinoplasty; cutting edge techniques of harvesting and carving, application of rib cartilage in primary and revision rhinoplasty, practical points for proper preoperative and postoperative care, and diced cartilage and homologous cartilage applications. I invited world renowned rhinoplasty surgeons who are specialists in dealing with rib cartilage use. I hope rhinoplasty surgeons who wants to use rib cartilage in their practice will benefit from the wisdom of the experts.
Recent posts

Deviated & hump nose correction

This lady in below photos had nasal deviation, hump nose, and tip ptosis with breathing difficulty. Septum was corrected first, and this made the lower 2/3 of the nose straight. Hump was not resected but rasped with Piezotome and this did not breach the keystone area, which made spreader grafts unnecessary.Bilateral osteotomies with Piezotome made her bone straight. Together with septum correction and effective osteotomies, her nose became straight from the frontal view. Tip was modified with sutures and onlay graft only. No strut or septal extension graft was used and this made the tip soft even after considerable amount of rotation and projection increase. Radix was augmented with bruised cartilage. Overall, she could breath much better after surgery and her nose became more harmonious and feminine.

Tip ptosis after rhinoplasty

This patient had silicone implant on the dorsum and tip surgery with septal and conchal cartilage. As time passes, the tip and supratip area dropped and a step deformity of the dorsum developed. You can see the short silicone implant on the dorsum from the X-ray and the subsequent step deformity on the preoperative lateral view in the middle. Silicone was replaced with autologous cartilage and tip ptosis was corrected with cartilage support. It is sometimes difficult to expect how much the tip projection will decrease as time passes, but with proper technique using autologous tissue, the margin of error should be within 10%.

short nose correction without using rib cartilage

This gentleman had a few failed previous rhinoplasties and finally ended up with upturned tip with nose contraction. At surgery, there was no allplast inside but a long K-wire fixed to the anterior nasal spine supporting the tip was removed. All cartilage grafts removed, recarved, and used as septal extension graft and extended spreader grafts to fix it. Skin was widely undermined to mobilize to the elongated new dome. Conchal composite graft was used to fill the gap between elongated skin and the deficient mucosa on the right side. Even though this is an early postoperative photos, you can recongnize the elongated nose with pushed down nostril margin and columella. Even without using rib cartilage, short upturned nose can be fixed effectively.

Two testimonials on realself by Australian and Canadian patients

https://www.realself.com/find/South-Korea/Seoul/Otolaryngologist/Hong-Ryul-Jin

Testimonial of an American patient who had hump nose refinement

Creating more feminine nose

The lady in below photos visited my clinic for rhinoplasty. She wanted to have more feminine nose instead of her muscline nose. She had a long nose with slight bump on the dorsum, overprojected, slightly bulbous and droopy tip, and slighly wide dorsum.  Surgery was focused on creating more feminine look: hump removal, narrowing the bony dorsum with osteotomies, tip volume reduction, decreasing tip projection, and slight cephalic rotation.  Photos taken 2 weeks after surgery (because she returnd back to her country after surgery) shows changes on the dorsum and the tip. Dorsum became slender with creation of smooth brow-tip aesthetic line. Tip was refined with volume reduction, slight underprojection, and cephalic rotation. Although the changes are not radical, her nose looks more feminine.