Rib Cartilage Rhinoplasty

How it works

Everything starts with an examination and a consultation. A specialist in Plastic and Aesthetic Surgery assesses the shape of your nose, the height of the bridge, the tip, whether your nasal skin is thick or thin, and your history of any previous nose surgery, while also checking whether the cartilage you have left is enough. The doctor talks through why your case calls for rib cartilage rather than another source, roughly how much cartilage is likely to be needed, and is clear about what the surgery can and cannot do for you. You also have routine pre-operative tests and a review by the anaesthetist.

There are a few things to prepare before the day of surgery. You will be advised to stop certain medicines that can cause bleeding, such as those containing Aspirin, for a period before the operation. If you smoke, the doctor will ask you to stop before and after surgery, because smoke slows healing. Rib cartilage rhinoplasty is usually carried out under general anaesthesia, because there is an added step to take cartilage from the chest.

During the operation there are two areas being worked on. First, the doctor removes cartilage through a small incision on the lower chest, usually placed along the rib margin or hidden in the fold beneath the breast so the scar stays discreet, then takes a length of rib cartilage that is enough for the plan. The doctor then shapes this cartilage into grafts and rebuilds the nose — raising the bridge, defining the tip, building the central support — through incisions in the nose. The incisions in the nose may be closed (lying entirely inside the nostrils) or open (with a small added incision across the strip of skin between the nostrils), depending on how much work is needed.

Throughout, the doctor works carefully in both areas — around the lining of the lung while taking cartilage from the chest, and around the supporting framework of the nose. Rib cartilage has a tendency to warp after it is shaped, so the doctor handles it in ways that help limit warping and positions the grafts so they sit stably. Once the shape is built and balance is checked, the doctor stops any bleeding, closes both the nasal and the chest wounds, usually places a splint on the outside of the nose, and may place supporting material inside the nostrils. The whole operation usually takes a few hours, longer than a standard rhinoplasty because of the added step of taking and shaping the cartilage. You are usually monitored afterwards and may stay overnight depending on your condition.

Recovery

Recovery happens in stages, and it is different for everyone. Because there are two surgical sites, you will see swelling and bruising around the nose and the area around the eyes, along with a sore, tight feeling in the chest where the cartilage was taken — and the chest soreness is often what catches people off guard, because it is noticeable when you breathe in deeply, cough, or move your upper body in the first few days. The milestones below are rough estimates to help you picture the journey, not exact figures for you alone.

The first few days

Swelling and bruising around the nose and eyes are at their most noticeable; the nose still has a splint and may have supporting material inside the nostrils, so you tend to breathe through your mouth. The chest feels sore and tight when you breathe in deeply, cough, or turn over. You take pain relief and antibiotics as prescribed, rest with your head raised, and take it easy.

Around 1 to 2 weeks

This is usually when the nasal splint comes off and the stitches are removed. Bruising and swelling in the face ease noticeably; the chest soreness settles gradually, though a tight feeling when you move your upper body may remain. Many people consider going back to office work during this stage if they feel comfortable.

Around 3 to 6 weeks

You gradually return to normal daily life. Strenuous activity, heavy lifting, and movements that strain the upper body are usually held back until your doctor allows them, so the chest and the nasal framework can settle.

Around 2 to 3 months

The remaining swelling keeps settling and the shape of the nose becomes clearer, especially the tip, which stays swollen longer. The chest is usually comfortable in everyday life by now.

Around 6 to 12 months

The deep swelling at the tip gradually clears, the cartilage framework settles, and the shape of the nose comes close to its final form. The scars on the chest and the central nose keep fading during this stage.

How we do it

Rib cartilage rhinoplasty is surgery on two areas at once: taking cartilage from the rib cage, near the lung lining, and rebuilding the supporting framework of the nose. The key lies in taking the cartilage safely, handling it to limit warping, and shaping the grafts so the nose is both balanced and firm over time. For this reason, the operation needs to be carried out by a specialist in Plastic and Aesthetic Surgery who is trained in this technique, at a hospital licensed for aesthetic surgery and equipped for anaesthesia and post-operative monitoring. These are conditions tied to your safety, not minor details.

At The Gioi Dep Plastic & Reconstructive Surgery Hospital, the person who examines and advises you also takes part directly in the operation, so what the two of you discuss about the nasal shape you want and the reasons for needing rib cartilage goes straight into the plan. The doctor will be honest about whether rib cartilage really is the right choice for you, even when the answer is that a closer, less involved source of cartilage would make more sense. Before surgery, you have a pre-anaesthetic assessment by an anaesthesia and critical care doctor, and after surgery you are guided on caring for both the nasal and the chest wounds, on follow-up visits to remove the splint and stitches, and on how to get in touch when you need to.