Rib Graft Rhinoplasty Replacement

Q: Dr. Eppley, I am interested in secondary rib graft rhinoplasty. I had silicone rhinoplasty done seven years ago. (they used silicone for the bridge and septal cartilage for the tip).Although I am very happy with it aesthetically, I also started getting autoimmune problems shortly afterwards and now have full-blown Lupus. While the link between silicone and Lupus isn’t firmly stablished, I don’t want to take any chances and would like to swap out the silicone for rib. Is there any way I could do this via closed rhinoplasty?

A: You are correct in that there is no established connection between solid silicone implants and autoimmune diseases currently. But I can certainly understand what you would want to replace your silicone nasal implant. While I have no idea of your implant’s size and shape, it can certainly be replaced with a rib graft. Some general comments about rib graft rhinoplasty in your case would include the following. It may be possible to use a closed approach for the replacement as the implant has an established capsule/pocket. Whether the rib graft should be inserted as a solid piece or in a diced fashion would depend the shape of the harvested rib and its ability to be inserted through a closed approach. It would be important to realize that any form of a rib graft may not have the completely smooth and perfect shape as that of a preformed nasal implant.

Dr. Barry Eppley
Indianapolis, Indiana