Revision Rhinoplasty: Should We Use Patient Rib Cartilage?

Why is a Graft Needed During Revision Rhinoplasty?

Revision Rhinoplasty is performed to improve the results of previous Rhinoplasty. This can be to improve breathing, the appearance of the nose, and often both. Graft material is almost always needed during this complex surgery to correct and maintain the form and function of the nose.

Types of Graft

The common grafts that I use in revision rhinoplasty are:

• Spreader grafts – to open up airway
• Alar baton grafts – for symmetry and to prevent nostril collapse
• Septal extension grafts – to improve and maintain tip position
• Alar rim grafts – to improve nostril shape

On certain occasions I will also use dorsal only grafts to increase the height of the nasal bridge.

The patient’s own septum is the ideal place to harvest graft but often will have been damaged or taken during the previous surgery. Ear cartilage is not strong enough to provide the support required. Rib cartilage is therefore the best option.

Cadaveric Grafts, and Why I Use Them

I personally made the switch from using the patient’s own rib to cadaveric rib graft 3 years ago. The advantages of using cadaveric rib graft are as follows:

1. No additional surgical site: The biggest advantage of using cadaveric rib is there is no need for an additional surgical site. Harvesting rib cartilage requires a separate procedure which adds to the operation time and/or requires an additional surgical team. It will result in a visible scar on the chest and potentially an indentation where the graft was taken. Most importantly, by using cadaveric rib cartilage instead of the patients own rib we avoid the risk of lung damage (pneumothorax).

2. Day-case surgery: By avoiding the need to harvest the patient’s own rib, revision rhinoplasty using cadaveric rib graft enables the surgery to be done as a day-case. This means the patient can go home the same day. Our surgeries are performed at 101 Harley Street in the heart of London’s medical district.

3. Abundant supply: The amount of graft required varies from patient to patient. With cadaveric rib there is no limit to the amount of graft available. This means it can be carved and shaped to fit the specific needs of each patient making it highly customizable.

4. Long-lasting results: Cadaveric rib grafts are strong and durable. Studies have shown that resorption and warping rates are comparable to the patients own rib (Saadi et al 2019).

I firmly believe the risk and morbidity associated with harvesting the patient’s own rib is too great to be worthwhile when cadaveric rib is available as an alternative.

How Safe is Cadaveric Tissue?

Our trusted supplier of Cadaveric Tissue, Hospital Innovations, says: "Very. The tissue bank who supply the cadaveric tissue are the largest private tissue bank in the UK; and have been supplying cadaveric tissue for over 15 years. Donors go through rigorous screening and testing before tissue recovery and there are various stages of processing prior to sterilisation. These important steps in testing, processing and sterilisation ensure the cadaveric tissue supplied is safe for use."