Using rib cartilage in rhinoplasty needs lots of attention both in patient's and surgeon's perspective.
For patient, it means additional incision on the chest, possible harvest site complications including chest pain, scar, and penumothorax, more cost, longer surgery time, and possibility of warping.
From the surgone's perspective, rib cartilage is usually the last resort of autogenous material for rhinoplasty. It affords a lot of possibilities for rhinoplasty such as dorsal augmentation, tip grafts, and lots of septal grafts, all of which are not possible with other autogenous sources. It also means a lot of experience is necessary for skillful use of rib cartilage.
I have used rib cartilage for rhinoplasty for more than 15 years. As cases accumulate, I can harvest the rib with small incision (less than 1.5 cm) without any complications such as peumothorax or severe pain. I do not cut the muscle and only retract it and this helps to reduce pain. Scar can be minimized with judicious closure. However, very rarely, hypertrophic scar develops and it can be managed with steroid injection and scar excision.
Warping of cartilage also decreased a lot with time, however, a very small percentage still develops warping. This occurs within 6 months and is managed with revision rhinoplasty or needle rasping at OPD when it is very minor. Warping only develops when a major dorsal augmentation is done with one piece of rib. This can be also prevented with stacking of cartilage pieces or dicing of cartilage and wrapping with fascia.
Anyway, time and experience taught me how to minimize possible complications associated with using rib cartilage in rhinoplasty. I believe rib cartilage is a great material of choice in many difficult situations of primary and reiviosn rhinoplasties. Judicious use of this material is non comparable to other materials of rhinoplasty, especially when alloplastic implant was removed due to complications.
For patient, it means additional incision on the chest, possible harvest site complications including chest pain, scar, and penumothorax, more cost, longer surgery time, and possibility of warping.
From the surgone's perspective, rib cartilage is usually the last resort of autogenous material for rhinoplasty. It affords a lot of possibilities for rhinoplasty such as dorsal augmentation, tip grafts, and lots of septal grafts, all of which are not possible with other autogenous sources. It also means a lot of experience is necessary for skillful use of rib cartilage.
I have used rib cartilage for rhinoplasty for more than 15 years. As cases accumulate, I can harvest the rib with small incision (less than 1.5 cm) without any complications such as peumothorax or severe pain. I do not cut the muscle and only retract it and this helps to reduce pain. Scar can be minimized with judicious closure. However, very rarely, hypertrophic scar develops and it can be managed with steroid injection and scar excision.
Warping of cartilage also decreased a lot with time, however, a very small percentage still develops warping. This occurs within 6 months and is managed with revision rhinoplasty or needle rasping at OPD when it is very minor. Warping only develops when a major dorsal augmentation is done with one piece of rib. This can be also prevented with stacking of cartilage pieces or dicing of cartilage and wrapping with fascia.
Anyway, time and experience taught me how to minimize possible complications associated with using rib cartilage in rhinoplasty. I believe rib cartilage is a great material of choice in many difficult situations of primary and reiviosn rhinoplasties. Judicious use of this material is non comparable to other materials of rhinoplasty, especially when alloplastic implant was removed due to complications.
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