Rhinoplasty Korea

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.

Diced cartilage in fascia was used in silicone-related contracted nose patient. She had a silicone implant on the nose and the tip was up-rotated due to contracture. Her nose looked short and the tip was upturned. Silicone was removed from the dorsum and the deficient dorsum was filled with diced rib cartilage in temporalis fascia. Her tip was elongated using septal extension graft and tip grafts. After surgery, her dorsum looks natural and the tip was refined with optimal lengthening.

Recently an Australian patient had a revision surgery using rib cartilage. She posted a thorough review of her journey on the web. You may want to look at it, so here is the link. So impressive not because she said good things on me, but because I could feel her pain and incredible efforts during her journey of revision rhinoplasty. https://forum.purseblog.com/threads/my-revision-rhinoplasty-at-dr-jins-premium-nose-clinic-2018-pt-1.994030/

This short video clip shows how I harvest a 4 cm rib cartilage from a 1.7 cm incision. Initial 1.5 cm incision changed into 1.7 cm incision with stretching. No muscle is cut during the dissection and it minimized postoperative pain. Incision heals well with meticulous suture. There is no need for admission and the patient can go home on the day of surgery.

This short video clip shows how a rib cartilage is changed into a graft for dorsal augmentation. It usually takes about 10 minutes to finely carve the rib and this process is repeated for 2-3 times before it is finally seated on the dorsum. Artistic sense of carving, relaxed mind, concentration, and perseverance are needed for this work. 

Removing deviated, problematic silicone implant and immediately replacing it with autolgous rib cartilage is a difficult job but it is worth trying. After removal of either deviated or protruding silicone implant, the dorsum is even more depressed than preoperative status. It is because the skin is thinned due to long-term stretching and the bony/cartilaginous dorsum is slightly resorbed due to pressure of silicone. After removing the silicone, the dorsum is closely observed and any irregularities or deviation of the dorsum is corrected if present before rib cartilage graft. Rib cartilage, harvested from the chest, is carefully carved without hurry. It is carved into a canoe shape so that the forehead to nose and face to nose transitions are smooth. Warping is prevented by using the central core portion and careful symmetric carving. Secure fixation of the rib cartilage to the dosrum is also important. Suture fixation, grafting perichondrium on the undersurface of the radix portion,...

This lady has deviated silicone implant and associated short, contracted nose. It is a very common complication of silicone implant rhinoplasty. Revision rhinoplasty included silicone removal, replacing the silicone with rib cartilage, and lengthening the nose and tip. Only autogenous materials like rib cartilage can enable all these procedures. Filling the empty, excavated dorsum with carved rib cartilage requires a lot of efforts. Tedious carving to prevent warping, secure fixation of the graft to the widely dissected dorsum, making a smooth transition from forehead to nose, prevention of an operated look, etc. Lengthening the contracted skin needs wide undermining of skin, making a stable flatform to fix the lengthened tip cartilage and skin, and filling the deficient vestibular skin if present. Behind the 3 series of pre and postoperative photos below lie 4 hours of focused efforts of a rhinoplasty surgeon.   

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 minimi...