Rhinoplasty with Rib Graft Removal

Q: I have a rib graft on the bridge of my nose which I would love to have removed. The surgery to place it was 12 years ago. At the time, the doctor thought my nose would be better off with the bridge higher. I liked my bridge before the rib graft. Is it possible to remove this graft? Is there any hope for me because I also dislike how it feels, not to mention how it looks which is not good?

A: Rib grafts to the nose are usually done for dorsal augmentation (building up the bridge, the distance between the top of the nose and the tip) secondary to prior trauma or rhinoplasty surgery or for altering certain ethnic noses. Whether dorsal augmentation is aesthetically beneficial, like all rhinoplasty changes, can be determined prior to surgery with computer imaging. The harvest of a rib graft and changing the dorsal line of the nose is not an insignificant adventure and everyone needs to be sure that it is a worthwhile procedure.

I have not found most rib grafts that hard to remove or manipulate in my experience, provided that they are completely composed of cartilage and are limited in location to the nasal bones and middle vault. Cartilage grafts to the dorsum, while wonderfully biocompatible, heal with a surrounding capsule and never truly integrate into the underlying structures like a bone graft would to bone. As a result, they can be usually be removed without as much difficulty as one would think.

The exceptions that make removal more difficult is if the rib graft was more bone than cartilage (which it usually isn’t) or if it was an L- strut configuration extending around the tip and down along the columella. It is not that the removal is that much more difficult, it is that it is more destructive to do. (more of the nose has to be taken apart to do it)

The description of a rib graft to the bridge of the nose done for aesthetic purposes suggests two things. The graft is small and probably all cartilage and that its location is just to the dorsal line of the nose. Both of these qualifiers would indicate that’s its removal is both possible and minimally destructive. Its removal, however, should be done through an open rhinoplasty approach even though it may have been placed initially through a closed or endonasal incision.

Dr. Barry Eppley