[Lari Plastic Surgery] Various Nose Surgeries Using Autologous Rib Cartilage: The Key Material in High-Difficulty Rhinoplasty

What materials come to mind when you think of [nose surgery]?!

Silicone, which creates the bridge of the nose,

septal cartilage, which forms the central support of the nose,

ear cartilage, which is soft and elastic,

and rib cartilage, which firmly supports the nasal tip,

are some examples.

Today, among these, let’s take a look at rib cartilage, the core support material in nose surgery.

What is rib cartilage?

Rib cartilage (costal cartilage)

is the cartilage that connects the ribs (rib bones, ribs) and the breastbone (sternum),

and is attached to the 1st through 10th ribs.

Rib cartilage includes autologous rib cartilage, which is harvested from one’s own ribs,

and donor rib cartilage, which is collected from another person’s cadaver and then sterilized.

Unlike septal cartilage or ear cartilage, which are less strong and limited in quantity,

rib cartilage is firm and available in sufficient amounts, so it is used as a strong support material in rhinoplasty.

The photo above shows autologous rib cartilage that was recently harvested directly from a patient.

With a length of over 3 cm and a substantial size, it shows a sufficient amount,

and unlike thin septal cartilage or ear cartilage, it has a three-dimensional, thick structure.

Advantages, disadvantages, and precautions of autologous rib rhinoplasty

As good and bad aspects exist together in everything,

autologous rib cartilage also has both advantages and disadvantages.

As shown in the table below, rib cartilage is strong and maintains a good nasal height,

and because it is the patient’s own tissue, it has the advantage of being favorable in terms of inflammation and contracture.

Over time, rib cartilage can also develop warping, where it bends.

To prevent warping, the necessary cartilage is carved according to the design,

then placed in sterile saline to check for bending in advance, and the surgery is performed accordingly.

At our clinic, we mainly harvest the 8th or 9th rib cartilage for surgery.

These areas allow rib cartilage to be harvested easily even with a small incision,

which helps minimize scarring,

and because the surgeon can relatively easily secure a clear view of the field, rib cartilage can be harvested more safely and more quickly.

Harvesting autologous rib cartilage

Photo 1 shows the rib cartilage immediately after harvesting.

Because the perichondrium has not been completely removed, it appears red, as if stained with blood.

When the perichondrium of the harvested rib cartilage is completely removed, it looks like in photos 2, 3, and 4,

showing that it can be harvested in a wide variety of sizes and shapes.

It is then carved into the height, thickness, and size suited to the area where it will be used, as in photos 5 and 6,

and used as the nasal tip support needed for surgery.

Various cases in which autologous rib cartilage is used in rhinoplasty

Autologous rib cartilage carved in the way described above is used in rhinoplasty in the following cases.

1. In revision nose surgery cases where septal cartilage or ear cartilage was already used in the first surgery

Because there is a shortage of materials available inside the nose, rib cartilage, which is sufficiently abundant and strong, is used.

2. When the skin is thick and does not stretch well

Even if it is not a revision surgery, if the internal support of the nose is weak, the nasal tip height cannot be maintained,

so rib cartilage is used as a firm support for the nasal tip.

(Cases with contracture are also included among cases where the skin does not stretch well.)

3. When the goal is to lengthen the nose or make the nasal tip very sharp and elevated

To lengthen the nose, a support that is long enough to extend the length

and can pull the skin with more force than the skin’s elasticity are needed.

Also, if you want the nasal tip to be especially higher and sharper,

a support structure strong enough to maintain that shape must be built,

so the use of rib cartilage is essential.

The fact that it is autologous tissue, that it is strong and firm, and that it can be used in the necessary various shapes without quantity limitations

makes autologous rib cartilage useful in many other cases as well.

Although autologous rib cartilage is sometimes used in primary rhinoplasty,

it is usually used in revision rhinoplasty or high-difficulty cases.

Because the process of harvesting, carving, grafting, and applying the cartilage requires advanced skill, experience, and delicacy,

it is important to consult thoroughly with an experienced specialist and proceed with surgery.