Revision Rhinoplasty Grafts: Septum, Ear or Rib?

13 hours ago

3 min read

Updated: 9 hours ago

When a nose has already been operated on, the missing piece is usually structure rather than shape. Revision rhinoplasty therefore starts with a supply question: where does the cartilage come from? There are three sources — the septum, the ear and the rib — and each behaves differently.

Septal cartilage

The first choice when it is still available. It is straight, firm, easy to shape into a columellar strut or spreader grafts, and it is harvested through the same incisions with no extra scar. The limitation is quantity: a previous septoplasty or rhinoplasty may have used most of it, and an L-strut of at least one centimetre at the dorsum and caudal border must be left intact to keep the nose supported.

Conchal (ear) cartilage

Harvested from the bowl of the ear through an incision hidden behind it, which does not change the ear's shape when done correctly. It is naturally curved, which makes it excellent for alar rim grafts, lateral crural strut grafts and camouflage, and less suitable where straight, load-bearing support is needed. Quantity is moderate.

Costal (rib) cartilage

The solution when major reconstruction is required: a collapsed dorsum, a short nose that needs lengthening, a destroyed tip framework. It provides as much material as is needed and is strong enough to carry the whole structure. The costs are a chest scar of a few centimetres, a longer operation, more post-operative discomfort for a week, and the tendency of rib cartilage to warp — which is managed by carving concentrically, balancing the graft, and allowing it to rest before final shaping. In older patients calcification can make carving harder.

Diced cartilage and its role

Cartilage that is diced and wrapped, or prepared finely enough to behave like a paste, is used to smooth the dorsum and soften transitions rather than to carry load. It is particularly valuable in thin-skinned revision patients, where a solid graft edge would show through. The closed atraumatic technique uses this extensively.

Donor cartilage from a bank

Irradiated homologous rib is used in some practices when a patient's own rib cannot be taken. It avoids a chest scar but carries a higher long-term resorption rate in published series, and availability and regulation vary by country.

What this means for your consultation

Ask which source the surgeon plans to use and what the fallback is if the septum turns out to be exhausted. A revision plan that has no answer to that question is not a plan. Ask, too, how the surgeon manages warping if rib is used, and whether the chest harvest is performed in the same session.

Frequently asked questions

Will I definitely need rib cartilage for a revision?

No. Many revisions are completed with what remains of the septum plus ear cartilage. Rib is reserved for cases where substantial structure has to be rebuilt.

Does taking rib cartilage hurt?

The chest is sore for about a week, which is usually the most uncomfortable part of the recovery, and it is managed with simple painkillers. The scar is a few centimetres and is placed in a fold or under the breast crease where possible.

Can ear cartilage change the shape of my ear?

Taken correctly from the conchal bowl, it does not. The framework that holds the ear's shape is left intact and the incision is hidden behind the ear.

How long should I wait after my first operation?

At least twelve months, so the tissue has softened and the true residual problem is visible. Severe breathing obstruction is the exception that is treated earlier.

Is grafted cartilage permanent?

Cartilage grafts survive well in the nose. Some resorption is normal, which is why surgeons slightly overcorrect certain grafts and prefer techniques with predictable behaviour.

Next step

Contact Prof. Dr. Suleyman Tas Clinic in Istanbul to have your own anatomy assessed and to discuss which approach fits it.

About the author

Prof. Dr. Suleyman Tas is a European Board-certified plastic, reconstructive and aesthetic surgeon based in Istanbul with over 20 years of experience, author of Rhinoplasty in Practice (CRC Press) and founder of the Closed Atraumatic Rhinoplasty Course. Read verified patient reviews or book a consultation.

This article is for general information and does not replace an individual medical consultation.