Dr. Jay Calvert, Secondary Rhinoplasty expert
Beverly Hills, CA
There is a real question as to how rib cartilage is used in the operation I do for secondary rhinoplasty.
The old school approach is to use big blocks of cartilage as on-lay grafts and make a nose that is essentially a construct of cartilage laying over the old structures.
Secondary rhinoplasty has evolved to a much higher level than this.
I use rib cartilage as a donor site for spreader grafts, septoplasty where the septum is reconstructed from the rib, lateral crural strut grafts, columella structs, and for the diced cartilage of the DC-F graft that covers the reconstructions grafts.
This is the so called composite reconstruction that has allowed for difficult reconstructions to be performed on so many levels.
With that said, the Anderson’s tripod concept has also been a real winner for me in the thinking about the functional/aesthetic approach to nasal tip reconstruction.
You see, the grafts we place are really there not only to hold the airway open, but also to maintain the projection of the tip and the rotation of the tip (or de-rotation as necessary).
By using revisiting this concept, one can see that the three legs of the tripod all have a balancing purpose for both function and aesthetics.
Couple this with the concept that Rollin Daniel presented at the Rhinoplasty society meeting in 2012 that at the nostril is an annulus, and you begin to see how to prevent problems with postoperative scarring that causes not only functional issues, but also alar notching, asymmetry, etc.
These concepts are not simple and doing something about the issues that arise in surgery is not trivial.
However, with the excellent supply of cartilage that comes from the rib, the secondary rhinoplasty surgeon can effect changes that afford excellent results!