rib graft Gregory S Dibelius MD

What is a Rib Graft?

This is a really important topic in revision rhinoplasty. I often ask many of my patients seeking revision rhinoplasty whether they have heard about rib grafting at any of their other consultations, because I like to know where to begin the conversation about this important topic.

In the simplest terms, a graft is a piece of tissue that is moved from one place in the body to another. Therefore, a rib graft is simply a piece of rim that is harvested from the chest and moved to another location, in this case the nose, for reconstructive purposes. It has many different functions in revision rhinoplasty which I will address in this post.

rib graft Gregory S Dibelius MD

So why would a rib graft be needed? The main reason a rib graft is needed is because the nose is lacking in some important structure, and our surgical goal is to replace that structure. Typically the preferred cartilage source is from the nasal septum, which is the anatomical separation between the right and left sides of the nose. However, in the setting of revision rhinoplasty, frequently the septum is missing or damaged from the prior surgery. This means that the surgeon is challenged to rebuild the nose with cartilage from another location. Because of its combination of strength, ease of use, and nearly infinite shaping possibilities, it is the most versatile graft for nasal reconstruction available. 

When I harvest a rib graft, I make an incision on the front of the chest, usually on the right side of the body.  The incision is usually around ½ of an inch long or so.  The benefits of doing it this way are many – but chief among these is that you are using your own tissue to do the surgery, which I feel is superior to other sources of tissue.  For example, donor cartilage can be used, and is frequently a reliable source of cartilage in patients who do not want to undergo a rib graft procedure. I would caution patients away from outdated techniques that involve implant materials like Gore-tex or silicone, as these do have more significant risks of infections and poor tolerance by the body.

Recovery from the procedure is a little more involved compared to regular nasal surgery, since the chest moves during breathing and laughing, but the down time is really the same, and patients can return to completely normal activity including sports once recovery is complete. 

One important note about rib grafts – I find that often patients are surprised to hear that their case is more complex than they anticipated.  A common situation where I see this is when patients who have had trouble with nasal breathing present to me having undergone a non-cosmetic septoplasty operation in the past, making a rib graft almost a necessity when taking on this case.  In fact, I tell all my patients considering a septoplasty for nasal breathing that they should be as sure as possible that they will never want a rhinoplasty operation in the future, and if they do, they should consider whether doing both at the same time makes sense to them. 

This is just an overview of some of the issues surrounding rib grafts used in rhinoplasty surgery.  Stay tuned for more posts on this important topic in the future.  And as always, if you think you may be a candidate for rib graft surgery or have any questions specific to your case, please make sure to arrange for a consultation with a board-certified facial plastic surgeon. 

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