Rib Graft Rhinoplasty
Q: Dr. Eppley, I am interested in a rhinoplasty to fix a retruded columella. I know a graft is needed to push out the base of the columella. One doctor told me that he would use septa cartilage. Isn’t the anterior nasal spine made of real bone, so wouldn’t you need something tougher than soft septal cartilage to do that? Would my nose lose structure/functionally feel weird if a piece of septum were missing? I’ve heard that some doctors use ears and ribs, what are your thoughts on that?
Also, do you feel that my nose tip need to be projected more forward and down, if the base will be lowered?
My other concern is about my nostrils. I think the outer corners droop down too much, hence I was asking about alar reduction (although that appearance could be exacerbated by the retruded columella).
A: In answer to your questions:
1) The anterior nasal spine is bone but you would never harvest a bone graft to place there nor would a bone graft persist. Cartilage is the correct choice, it is just a question of the quantity needed and the best donor site. Without question rib cartilage is best both in quantity and structural stiffness…if the patient does not mind a small chest scar to harvest it.
2) As the columella is rotated downward you are correct in that the tip projection will look less. As long as one has enough cartilage to graft, then the tip projection and rotation should adjusted accordingly. Like #1 the rib graft re-emerges and is essential if this nasal change is done. A rib graft rhinoplasty is the procedure you appear to be needing.
3) I think that the alar appearance is exacerbated by the retruded columella. Since any change to the alar rims requires an incision, I would not commit to the need for that change until one sees it in perspective of the columellar correction.
Dr. Barry Eppley