Can Diced Cartilage Be Replaced by A Solid Rib Graft In A Secondary Rhinoplasty Procedure?

Q: Dr. Eppley, is it true that it is hard to have a bloc rib cartilage inserted into the nose since I've got so many diced rib cartilage pieces in the nose? Will the surgery be somewhat messy and exhibit unpredictable outcome? A surgeon I consulted said he may need to remove all those diced pieces and that he doesn’t believe I will have enough rib cartilage to be harvested and carved into a bloc graft. I was somewhat speechless, because I thought rib cartilage is abundant. Then he pointed out that since I'm already 26 years old most of the rib cartilage has ossified. I'm really confused. Please help, thanks very much Dr Eppley.

A: With a prior diced cartilage graft nasal augmentation, it does make it more difficult to replace it with a new solid cartilage graft. But just because it is a little more difficult does not make it impossible. Many times diced cartilage grafts can be removed without a lot of difficulty because they have fused into a near solid mass that is held together by scar/fibrous tissue. I do not see the inswelling diced cartilage being a big obstacle to a second effort at a rhinoplasty for more dorsal augmentation. It is not true that at age 26 most of your ribs are ossified. I can assure you that your ribs # 6,7,8, and 9 are still very cartilaginous and abundant.

Dr. Barry Eppley

Indianapolis, Indiana