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Rib Rhinoplasty

Rib RhinoplastyIn any rhinoplasty procedure, structural support in the nose is paramount for natural, beautiful, and lasting results. Structural support is also a prerequisite for sustained functional breathing. The upper third of the nose is supported with the nasal bones, and the bony portion of the nasal septum (the midline wall inside the nose). Cartilage comprises the support for the lower two thirds of the nose, including the front part of the septum, and upper lateral cartilages (attached to the nasal bones), and the nasal tip cartilages (alar cartilages). Cartilage damage to the nose secondary to past rhinoplasty, assault injuries, sports or motor vehicle injuries, drug use, or autoimmune vascular compromise, can lead to deformation or collapse of the involved sites. Restoration of form and function during rhinoplasty often requires the use of cartilage as graft material. Typically, septum cartilage (the wall in the middle of the nose) is the best source material during rhinoplasty. However, septum cartilage may not be available or insufficient for intended use during rhinoplasty. In such cases, we can use ear cartilage or rib cartilage. Rib cartilage has several advantages: it is plentiful, strong, and straight. In instances of major nasal reconstruction, rib cartilage is our go-to source material for rhinoplasty.

There are two possible sources for rib cartilage: rib cartilage harvested from the patient (autologous), and rib cartilage available from commercial suppliers of cadaveric tissue. In general, we prefer autologous rib cartilage because of lower risk of rejection or infection. Additionally, the autologous cartilage quality is often superior since cadaveric rib is manipulated chemically and with radiation to eliminate any active biologic or infectious materials from the donor. Autologous rib is easier to shave, contour, and manipulate.

Autologous rib cartilage is harvested as a precursor to rhinoplasty. The procedure takes one hour to perform. We commonly use the sixth or seventh rib from the right side of the chest. Rib RhinoplastyThe small incision in the chest results in a well-hidden scar. There is no visible depression or deformity at the site of rib harvest. The rib cartilage is then cut into appropriate grafts to be used during rhinoplasty. The cadaveric cartilage has the advantage of being available off-the-shelf in a frozen package. There is no additional incisions or surgical time.

In choosing which source of rib cartilage during rhinoplasty, we have a thorough discussion with each patient in reviewing the advantages and risks of autologous cartilage vs cadaveric rib cartilage. In the older patients, who may be at risk for additional time under general anesthesia, we favor the cadaver rib option. In healthy and younger patients, in patients with vascular compromise such as Wegener’s, and in cases where large volumes of cartilage are necessary such as saddle nose deformity, we recommend autologous rib cartilage. The ultimate decision on which option to use is made jointly with the patient.

The most common scenarios for use of rib cartilage are revision rhinoplasties. In cases of failed rhinoplasty, often too much supporting cartilage is removed, resulting in a bridge that is too low, nasal tip that is pinched, or a tip that is excessively upturned. Rib cartilage is also commonly used in patients who develop saddle nose deformity. Saddle nose is collapse of the middle part of the nose due to loss of support from the septum, usually seen in patients with autoimmune vascular problems or associated with septum perforation due to use of recreational drugs. Traumatic deformities of the nose are the next common indication for rib cartilage rhinoplasty. Having had extensive experience in harvest of autologous rib cartilage and performance of reconstructive and revision rhinoplasties, Dr Khosh is uniquely qualified to address the most intricate and complicated rhinoplasty cases.

Case Study

This 35-year-old woman who developed saddle nose collapse due to Wegener’s granulomatosis leading to a septum perforation and loss of nasal bridge support. Autologous rib rhinoplasty allowed the recreation of a natural looking nose with excellent breathing function.

  • Patient: 35 year-old man seeking rhinoplasty to address saddle nose deformity in Manhattan
  • Problem: Septum perforation with loss of support in bridge of nose.
  • Procedure: Autologous rib rhinoplasty performed through the open approach

Disclaimer: These are actual results for patients of Dr. Maurice Khosh. Plastic and cosmetic surgery results can vary between patients.

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What Dr. Khosh's Patients Say

5.0

Based on 174 reviews

Meredith G.
Saw Dr. Khosh for a fractured nose. He reset my nose beautifully (and with little discomfort to me) and then discussed some of my sinus issues with me upon my follow up visit. Never felt like he was rushing me out and felt very confident in his abilities. I would highly recommend to anyone needing plastic or reconstructive options!
Jackie C.
Great front office, really good experience after what was a terrible accident. I was made to feel comfortable. Dr. Khosh is very good at what he does. I'm still healing but I'm confident of the results
Kaitlin M.
Dr. Khosh takes exceptional care of his patients. He has operated on me twice, each time making me feel extremely comfortable and satisfied with the results. His staff is also very kind and knowledgeable.
Diana G.
Dr. Khosh & his staff Susan & Christine are absolutely amazing! They were so supportive & helpful from beginning to end & they are just wonderful people. Thank you guys I truly appreciate everything you guys have done for me. I would recommend them to anyone & everyone!
Joann M.
After visiting and being evaluated by several doctors, I kept going back to Dr. Khosh. His tranquil spirit and professionalism were captivating. Thank you for a job well done and keeping me calm throughout the entire process. A special thanks to your staff Susan and Christine for all of their support as well. Hi highly recommend Dr. Khosh.
Leah G.
Upon hearing of the overwhelmingly positive experience a friend of mine had in choosing Dr. Khosh as her surgeon, I decided to make an appointment for my own septoplasty/rhinoplasty/turbinate reduction. Although I was slightly skeptical as the praise I had heard seemed a bit hyperbolic, all uncertainty dissipated after meeting the Doctor and his staff. My pre- and post-operative experience was excellent in terms of concerns adequately addressed prior to the surgery and mitigation of any bruising in the convalescent period. Despite my apparent predisposition to rather slower healing, a year after the surgery, my nose looks really pretty and my breathing entirely unobstructed! I highly recommend Dr. Khosh!
Courtney G.
AMAZING!!!!!! I had Dr Khosh perform lipo on my chin/neck and my result is unbelievable! Better than I could have expected! I met with a couple of surgeons and the second I met with Dr Khosh I knew he was the one I was going with. He was compassionate and explained every detail of what would take place during the surgery and what to expect during recovery. I even emailed a few times during recovery with various questions and he got right back to me asap which was really comforting! I honestly fully recommend Dr Khosh, he did an amazing job and is an amazing person.
Frieda S.
i can finally breathe!! Dr. Khosh made the entire experience a breeze, it was truly a pleasure to be under his care. I am forever thankful and highly recommend him. Not only does his work speak for himself, but he has excellent bedside manner. His kindness and patience is above and beyond. He takes the time to answer to every question you have to help you understand the process while at the same time making you feel so comfortable. From the first consultation i knew i was in good hands. I am so pleased with the result and forever thankful.
Facial Plastic Surgery logo. Americany Academy of Facial Plastic and Reconstructive Surgery, Inc.Castle Connolly Top Doctors 2021Best Doctors logoLogo Super Doctors New York 2020 Rising Stars EditionTop Patient Rated New York Plastic Surgeon 2019Top Patient Rated New York Plastic Surgeon 2020Top Patient Rated New York Plastic Surgeon 2021
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Maurice M. Khosh, MD, FACS
Facial Plastic & Reconstructive Surgery
Nasal & Sinus Surgery

580 Park Avenue Suite 1BE,
New York, NY 10065
(212) 339-9988
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Maurice M. Khosh, MD, FACS office lobby. Purple walls, mirror, an orchid on a beautiful table.