Rib Graft Revisions: A complex situation
Several years ago, I started seeing a group of patients who had had rib graft revision rhinoplasty elsewhere and were not happy with their results. They were coming to me to have revision surgery of their rib grafts! We realized the need to track the outcomes of operations on patients who had ALREADY had a rib cartilage graft to repair their failed rhinoplasty. The results were published in the journal, Plastic and Reconstructive Surgery. This article analyzed a cohort of patients operated by the lead author, Dr. Jay Calvert (me). The article looked at the results of these re-operative procedures. You can read the article here
This article, published with Dr. Rollin Daniel and Dr. Anita Patel showed the efficacy of these revisions. In general, the patients did not require a new rib graft, but still, about 1 out of 5 patients did need new rib cartilage! In some cases, this was anticipated and in some cases it was not. The interesting finding, though, was the higher than expected revision rate of these rib graft revisions. Most would anticipate a revision rate of 15% since that is the national average for all comers to rhinoplasty. Maybe, based on the complexity of these operations, one could expect a bit higher of a rate. However, the revision rate was 24%. This is significantly higher than the national average.
What types of revision were needed?
A large number of patients main complaint that brought them in was that the nose was just too large. This is understandable since carving rib grafts can make for large noses IF the surgeon does not pare down the size of the grafts. There are many ways to use rib cartilage and not all are created equal. Some surgeons carve the grafts thin and simply use the cartilage as donor cartilage, Some surgeons use the grafts as huge on-lay grafts that dominate the nose and the face. Technique is everything! My personal preference is that the rib cartilage is simply a donor site. I rarely do any kind of dorsal en bloc on-lay graft. I just don’t like the way they look. I do prefer the diced cartilage with fascia as a way to create a great looking dorsum.
For more information about Rib Graft Revisions, please feel free to contact Dr. Jay Calvert or his staff to discuss your case. The office can be reached at (310) 777-8800 or (949) 644-2858 or contact us.