Candidates, indications vary for harvesting rib cartilage in rhinoplasty
NEW ORLEANS — Costal cartilage harvesting can offer advantages with regard to performing rhinoplasty procedures, but it requires a certain finesse, according to a speaker here.
During the American Academy of Cosmetic Surgery Annual Scientific Meeting, Anthony Bared, MD, discussed how to safely harvest rib cartilage, as well as when and how it is used in surgical practice.
Bared uses rib cartilage mostly in revision rhinoplasty, specifically in patients with major middle vault deformities, in cases that require significant tip support, for alar retraction and for addressing saddle nose deformities. Additionally, in cases involving a foreshortened nose, the cartilage can help correct an upturned tip or dorsal augmentation, he said.
In primary surgical cases, rib cartilage is helpful in cases of near total septal perforation, such as from cocaine use, and with significant trauma, according to Bared.
He explained that despite the utility of rib cartilage, harvesting the cartilage involves a much higher learning curve and longer operative time, and a chest incision is necessary.
“I believe it takes over 100 cases to develop the various finesses it takes to use rib cartilage,” Bared said.
As for the advantages of harvesting rib cartilage, Bared said an abundance of cartilage can be excised, comparable to three ears’ worth. The cartilage strength is ideal, and the perichondrium is considered, “the gold of the rib,” according to Bared, able to be preserved for surgical use.
Bared recommended this type of procedure for patients younger than 45 years. In older patients, however, he preoperatively tests the patient under local anesthesia with a needle to palpitate over the rib to determine whether it is calcified. – by Abigail Sutton
Bared A. The use of costal cartilage in revision rhinoplasty. Presented at: American Academy of Cosmetic Surgery Annual Scientific Meeting. Jan. 13-17, 2015; New Orleans.
Disclosure: Bared has no relevant financial disclosures.