Q: Dr. Eppley, I am interested in revision rhinoplasty. I had a rib graft placed last year and now it is quite deviated. I want to straighten my nose and it should be a bit higher. What I don’t understand is why the rib graft was ok in the beginning and now it has deviated so much. Can you morselize the deviated part and put it back in. Will the morselized parts be healed like bone does? Will the nose be deviated again? If I go with a nasal implant instead of the rib graft, will it have any chance to deviate again? And will you have to harvest ear cartilage for the nose tip or you can utilize the cartilage that they used in the previous surgery?
A: It is not rare that a rib graft to the nose will eventually develop some deviation. This is a function of its natural curved shape and the memory of its cartilage shape. No matter how the rib graft is harvested it is rare to ever get a perfectly straight piece. As a result it must be carved to be straight. Depending upon how it is carved and where it was harvested along the subcostal margin, deviation can develop. Usually it appears quite soon after placement (a few months) but can be delayed in its appearance much later.
If the goal is a straight nose that is higher, then the rib graft should be replaced with a nasal implant in your revision rhinoplasty. A nasal implant will have more assured straightness since it is made straight. The tip of the nose and the columella, however, should remain cartilaginous, most likely using the rib graft which was removed.
If the goal is simply a straight nose with the same height then the rib graft should be configured into a diced cartilage graft for your revision rhinoplasty. This will eliminate ant risk of subsequent graft warping.
Dr. Barry Eppley