Can The Ribs Removed In Rib Removal Surgery Be Used To Fix A Bad V-Line Surgery?
Q: Dr. Eppley, I had facial feminization surgery with very bad results. My chin was amputated instead of contoured or a genioplasty. My mandibular angles were totally obliterated too. This has left my face looking unnatural and with a U shaped. My chin pad hangs below my chin bone now.
I’m interested in Rib reduction too as i have a rather straight waist, very short torso, 5’7″ tall, ~30″ waist inspite of being thin due to being born a man (I transitioned 3 years ago)
My question is can my ribs be reduced by a couple of inches?
Can the rib bone be grafted to make my chin better and give me some mandibular angles. (Even if only a slight augmentation is desired)
Even if rib reduction is not possible can I still get a rib bone or other graft to make my facial harmony better? Im also scared of losing more bone as I age and having danger to my teeth.
I have enclosed CT scan images post op and can provide complete ct scan zip folder too.
Please do help, if possible. After all this I still look male in person.
My main concern is my face shape, and I’m terrified of choosing implants as I barely have a few mms of bone left in my chin.
A: Thank you for your inquiry and sending your 3D CT scans. Like all 3D facial CT scans they speak for themselves about the state of your chin (an amputation chin reduction is a very unusual procedure given the objective) and the not atypical amputation of the jaw angles in V line surgery. (albeit with a very high starting point to begin the bone cut)
While custom implant designs are the far superior method of subtotal chin and jaw angle reconstruction after any form of V line surgery, and there are no long-term bone loss issues with such implants, your question of whether bone from rib removals can be used for the chin and jaw angle reconstructions is a logical and reasonable one.
The length of ribs removed varies depending upon which rib is being taken. Rib #12 is usually in 5 – 6 cm range, and ribs #11 and #10 are in the 10 to 12 cms range. Such ribs are usually 1.5 to 2 cms wide. Given these bone lengths their additive amount should suffice for the chin and jaw angle reconstructions.
The issue with using rib bone for the chin and jaw angles, and this applies to any bone graft on the jawline whose objective is to expand the existing contours, is how much of it will survive. Onlay bone grafting can have different volumetric fates than inlay bone grafting in the face.
But the recycling of bone from rib removal instead of merely being discarded is not completely novel. Its most common recycled use in my experience is in augmentative rhinoplasty.
Dr. Barry Eppley