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Using Rib Cartilage in Revision Rhinoplasty

Revision rhinoplasty is one of the most rewarding and challenging surgeries in facial cosmetic surgery.  Patients seeking a revision rhinoplasty in Charlotte normally come to my office with a different mindset than patients who are seeking their first nose job. For whatever the reason, patients seeking a revision are normally unhappy with their previous results. This unhappiness has normally led to a change in self confidence and a diminishing in their confidence and trust in doctors.  More than any other facial aesthetic surgery, a revision nose job should be done by a nasal specialist, due to the complex anatomy of the nose and importance of the appearance of the nose for the overall look of the face.

When seeing a patient at a consultation for a revision nose job, I inquire about their previous rhinoplasty(ies), their goals, and their desires. After establishing a trusting relationship between both parties, I develop a surgical approach to improve the nose.  I use two general approaches:

1)  Camouflage Revision Rhinoplasty

2)  Reverse Reconstructive Revision Rhinoplasty

In a camouflage revision nose job, the nose has proper underlying support, but has a poor appearance.  In this situation, I will use either an open or closed rhinoplasty approach to place tissue, grafts, and sutures to refine the nose and create an appealing appearance.

In a reverse reconstructive revision rhinoplasty, the nose has collapsed, lost its supporting foundation, and patients are normally unable to breath through the nose. These patients require the facial plastic surgeon to rebuild the underlying cartilaginous support to the nose and reconstruct it.  This may require a significant amount of straight and strong cartilage. The first option for cartilage is septal cartilage.  Often this cartilage is not available due to its removal during a previous surgery.  The next available option is ear cartilage in combination with a new product, PDS plate.  The ear cartilage is not straight or strong enough to reconstruct a nose.  The PDS plate is a sheet of suture material that straightens and strengthens the cartilage so it may be used in nasal reconstruction.

The final option for cartilage is to take it from the rib.  This cartilage is very strong and straight and is the best material to use when rebuilding a collapsed nose.  Typically, a small incision is hidden in the breast crease.  The patient will not experience any changes in their breathing or have a hole in their rib cage.  In fact, sometimes the rib will actually partially reform!  I will only use this procedure if it is absolutely necessary.  I believe as a rhinoplasty specialist, it is imperative to offer this procedure as there will be some patients that require rib cartilage.

Other surgeons will use foreign implants in the nose.  While this can be an option, I prefer to use the body’s natural material and believe using your own rib is safer in the long term.

Revision nose jobs in Charlotte should be done by a nasal specialist.  Dr. Kulbersh is a facial plastic and reconstructive surgeon who completed special training and has a vast interest in revision nose jobs.  He has offices in Charlotte and Columbia.

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