Rib cartilage in revision rhinoplasty

Why does Prof Dr Nazım Çerkeş use rib cartilage in revision rhinoplasty?

I have been operating more and more secondary rhinoplasties and complex secondary cases. In complex secondary cases, the osseocartilaginous skeleton is usually destroyed due to previous surgeries. Without restoring the osseocartilaginous structures it is not possible to achieve an aesthetically pleasing and functional nose. In deformed and over resected noses, significant amounts of cartilage grafts are required to reconstruct the cartilaginous framework. In these cases we need strong grafts to resist the scar forces during the healing period.

Recently, I have described a new technique for fascia graft harvesting from the chest region. In this method both fascia and rib cartilage can be harvested through the same incision. So an additional incision and donor site is eliminated. In the past I would place another incision to the temple area for harvesting the fascia graft. My technique is rapidly becoming popular among plastic surgeons with its certain advantages, particularly eliminating the additional donor site.

Rib provides us unlimited amount of cartilage. A block of cartilage approximately half the size of an index finger can be harvested .We prepare different sized cartilage struts from the harvested cartilage depending on necessity of the patient. Using these struts the septum cartilage and tip cartilages can be reconstructed. If the nose bridge was reduced too much in the previous operations, it can also be augmented using rib cartilage. In such cases I harvest a strip of fascia also at the rib region and prepare a fascia tube. Then I dice the rib cartilage into a very small bits and fill them into the fascial tube. This diced cartilage-fascia graft is placed on dorsum of the nose to augment the bridge.

Many patients believe that rib cartilage harvest is painful and has more morbidity. It is not exactly true. In female patients we place the incision just on the fold under the breast, so the scar is not noticeable and majority of them have not experienced significant pain on the chest after the surgery.

Also, cartilage harvest from the rib does not create any aesthetic and functional deformity at the chest region.

 Many of my patients ask me why you don’t use ear cartilage in secondary rhinoplasty operations?

The first reason is the shape of the ear cartilage. It has curvatures and is not useful for straightening of septum cartilage deviations. Secondly, it is not as strong as the rib cartilage and may deform with the scar forces during the healing period. Thirdly , ear cartilage is not sufficient in most of the secondary rhinoplasty cases. If the nose is overreduced in the previous operations, significant amount of cartilage graft is needed and both ear cartilages may be insufficient to reconstruct the nose. Lastly , ear cartilage harvest has a risk of deforming the ear.

Today in majority of the secondary cases, fascia with cartilage grafts are being used.