Is A Rib Graft or Implant Better For Asian Rhinoplasty?

Q: Dr. Eppley, the things I wanna improve is my center part of the face which is like dented from the side, but I look okay from the front. I think it also because of my chin shape but I think the risk of having orthognathic surgery is too high. Therefore, I want to consult to see what is the best way for improving it.

A: Thank you sending your picture  and detailing your facial concerns. Like many Asian patients there is a general mid facial profile concavity appearance which is manifest both in the nose and midface as well. Since you have specifically mentioned rhinoplasty I will focus my comments just in this facial area.

An augmentative approach to rhinoplasty is the standard procedure in the Asian face. Such augmentation efforts, unlike many Caucasian rhinoplasties, requires significant augmentation efforts which always comes down to using rib grafts vs implants. (and when I refer to implants I mean thee contemporary use of ePTFE implants not the older use of pure silicone implants) This is a classic discussion in the Asian rhinoplasty patient for which there is no perfect answer as either can be used successfully and I have done many with both augmentative approaches. It really comes down to the patient understanding their different risks and choosing which risk profile is more appealing. Such an implant vs autologous graft discussion is well chronicled and comes down to:


  1. advantages = low to negligible risk of infection, natural material that will never cause any problems long-term once well healed, adequate graft material for all aspects of the rhinoplasty including tip without teh need for sept or ear graft harvests
  2. disadvantages = donor scar, longer recovery, graft warping/asymmetry


  1. advantages = no donor scar, more assured straight result as the implant is straight
  2. disadvantages = higher risk of infection, will still need ear or septal graft for tip augmentation as an implant is never placed  across the nasal tip area

As can be seen neither a rib graft or implant approach to significant rhinoplasty augmentation in the Asian nose is perfect, each has their own advantages and disadvantages.

Dr. Barry Eppley

Indianapolis, Indiana