Use Of Rib Cartilage in Nose Surgeries

Nose surgeries are operations where all procedures involve the tissues, bones, and cartilages of the nose, with the bones and cartilages being operated on. Therefore, it is crucial to perform procedures on the bones and cartilages that are appropriate to the anatomical structure, and to enlarge or reduce them proportionately. In cases of poorly performed nose surgeries, such as over-reduction of a hump, or excessive removal of septal cartilage during surgery, a patient might be left with a collapsed appearance that becomes apparent after the swelling subsides. The goal of a successful rhinoplasty is not only to achieve a pleasing appearance but also to ensure a natural feel even when touched. If cartilage is unnecessarily removed during surgery, the nasal dorsum becomes irregular, or if the existing cartilage in the nose is unusable, cartilage can be taken from the rib to reconstruct the nose.

Although nasal implants were used in the past for such cases, they have largely been discontinued as these materials often do not integrate well with the nose. Today, rib cartilage is more commonly used. Rib cartilage is advantageous because, once placed in the nose, it does not cause any complications and remains healthy in the body for life, unlike nasal implants.

When rib cartilage is harvested, a 4-5 cm incision is made under the breast fold in women to access the rib cartilage. In men, an incision is made at the level of the lowest rib. In both men and women, the goal is to ensure that the incision scar is not visible externally. In rhinoplasty procedures where rib cartilage is used, the nose achieves the desired healthy and aesthetic appearance, so the patient usually does not mind the small, faint scar left on the body.

Especially in recent years, with advancements in technology, rhinoplasty procedures using rib cartilage are performed without the patient experiencing any pain or discomfort, thanks to muscle-sparing techniques and general anesthesia. The fact that cartilage has been taken from the rib does not lead to any functional deficiencies in the patient’s life after surgery, and the postoperative period is quite comfortable.

There are many factors that influence the decision to use cartilage tissue from a different area during rhinoplasty. Cartilage can also be taken from the ear, but because ear cartilage is not flat and its structure varies from person to person, it may not always provide sufficient tissue or be usable in all areas. For rib cartilage, doctors recommend that patients be younger than 30-40 years old because aging causes ossification and structural changes in the ribs, making them less suitable. While the incision made for ear cartilage is not visible, the incision for rib cartilage may leave a faint scar. The patient should be aware of this when accepting the surgery.

Is it Necessary to Use Cartilage in Nose Surgery?

In fact, rhinoplasty can be performed through normal methods. The reason for using cartilage tissue is often due to the patient having a severely traumatic nose, congenital nasal deformities, or having undergone previous surgeries without achieving the desired outcome. Rhinoplasty surgeons may prefer to have cartilage readily available to reshape the nose once again, particularly when certain risks are present. The nasal region is already sensitive, so it is not always possible to perform various procedures on the nasal bone and cartilage structure, leading to the use of cartilage tissues. When this situation is explained to patients by rhinoplasty surgeons, they often wonder if it is necessary to use cartilage tissue. While the primary evaluation is always made by the rhinoplasty surgeon, if the patient has one of the conditions mentioned above, rib cartilage is used in the surgery. Factors considered by rhinoplasty surgeons include the nasal hump, nasal deviation, asymmetry in the nasal bones, the necessity of intervention on the nasal wings, whether the patient has experienced trauma, whether the patient has had previous surgeries, and if so, how many times and by what methods.