Rhinoplasty Korea

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,...

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...