Why Is Rib Cartilage Better For An Ethnic Rhinoplasty?

Q: Dr. Eppley, I have some questions about the best material to use in an ethnic rhinoplasty. (I happen to be Asian) Surgeons seem to prefer rib cartilage because they feel it is safer. How big would the scar to take it be? Could you provide me with more information about using rib cartilage. I have looked at some before and afters with a couple of different docs and it seems you are able to do more with rib cartilage to achieve the rather large difference I am looking for as far as height of the bridge and tip goes. What do you think of the noses in the desired result photos I have attached?

A: In further detail about rhinoplasty augmentation, there is no question in my mind that the better long-term material for many ethnic rhinoplasties thqt require significant dorsal augmentation as well as tip projection by grafting is cartilage. To not limit oneself by the amount of graft material, rib cartilage is always better because there is no restriction on volume. While rib graft rhinoplasty is harder on both the patient and the surgeon, and there is a resultant scar, your own tissue is always best over the rest your long remaining lifetime. Speaking of the scar, it is about 3.5 cms long low along the costal margin on the left or right side. (lower end of the middle of the rib cage) I usually take it from the opposite of the patient’s hand dominance so there may be less discomfort afterwards with less arm/body motion. While some surgeon’s use the rib graft as a whole block that is carved for dorsal augmentation, I find it much better to cut the rib grafts into tiny 1mm pieces (cubes) and rhen placed those inside a wrapped collagen sheet, making a moldeable implant. (aka diced cartilage graft) Then once it is placed it can be shaped into the desired form and amount of augmentation. Once held together for a week with the nasal splint, it becomes quite firm amazingly quickly. This not only makes for a customized shaped graft but avoids the biggest problem with dorsal rib grafts…malposition and warping. There is also the possibility of a little external molding when the splint is removed for adjustment until it becomes one firm solid graft.

In looking at some of the noses you sent, the question is whether your nose can achieve that look. I think the best way to think about it is probably not. There noses are more refined and, most importantly, they have thinner skin…the final determinant that ultimately influences much of a rhinoplasty result. But with significant dorsal augmentation, a columellar strut to increase nasal projection and a tip graft, you will end up a lot closer than where you are now.

Dr. Barry Eppley