Facial Plast Surg 2019; 35(01): 031-046
DOI: 10.1055/s-0039-1677801
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Current Practical Concepts for Using Rib in Secondary Rhinoplasty

Enrico Robotti
1   Department of Plastic and Reconstructive Surgery, Private Practice, Bergamo, Italy
,
Waldemar Brandao Penna
2   Department of Plastic Surgery, Private Practice, Belo Horizonte, MG, Brazil
› Author Affiliations
Further Information

Publication History

Publication Date:
13 February 2019 (online)

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Abstract

Rhinoplasty is universally considered as the most demanding procedure in facial plastic surgery. Secondary rhinoplasty is its crown jewel, even more complex, and likewise highly fascinating. The evolution of thought and practice in rhinoplasty in the last decades has been quick and steady, progressively acknowledging the importance of maintaining structure in primary rhinoplasty and rebuilding structure in secondary procedures. No longer is the paradigm to achieve a small, thin, and pointy nose, but rather a well-proportioned nose which looks natural, albeit elegant and breathing well. Rib is an essential tool in many secondary procedures, and thus some important concepts have to be well understood and some finesse points mastered. This will provide an elegant reconstruction, identical if possible, or at least not far apart, to what could be achieved by a well-executed primary rhinoplasty, while avoiding the feared luck of a bulky nose stuffed with grafts. These guiding concepts and specific nuances regarding harvesting rib and working with it are the scope and contents of this article.

Keywords

graft - rhinoplasty - rib cartilage

Statement of Authorship

Both authors had substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data, drafting the article, or revising it critically for important intellectual content, and approved the final version to be published.


 

  • References

  • 1 Toriumi DM. Subtotal septal reconstruction: an update. Facial Plast Surg 2013; 29 (06) 492-501
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Gubisch W. Secondary Septoplasty. In: Gubisch W, ed. Mastering Advanced Rhinoplasty. Cham, Switzerland: Springer; 2017: 37-123
    Google Scholar
  • 3 Wee JH, Mun SJ, Na WS. , et al. Autologous vs irradiated homologous costal cartilage as graft material in rhinoplasty. JAMA Facial Plast Surg 2017; 19 (03) 183-188
    CrossrefPubMedGoogle Scholar
  • 4 Marin VP, Landecker A, Gunter JP. Harvesting rib cartilage grafts for secondary rhinoplasty. Plast Reconstr Surg 2008; 121 (04) 1442-1448
    CrossrefPubMedGoogle Scholar
  • 5 Toriumi DM. Dorsal augmentation using autologous costal cartilage or Microfat-infused soft tissue augmentation. Facial Plast Surg 2017; 33 (02) 162-178
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Cerkes N, Basaran K. Diced cartilage grafts wrapped in rectus abdominis fascia for nasal dorsum augmentation. Plast Reconstr Surg 2016; 137 (01) 43-51
    CrossrefPubMedGoogle Scholar
  • 7 Foulad A, Hamamoto A, Manuel C, Wong BJ. Precise and rapid costal cartilage graft sectioning using a novel device: clinical application. JAMA Facial Plast Surg 2014; 16 (02) 107-112
    CrossrefPubMedGoogle Scholar
  • 8 Farkas JP, Lee MR, Lakianhi C, Rohrich RJ. Effects of carving plane, level of harvest, and oppositional suturing techniques on costal cartilage warping. Plast Reconstr Surg 2013; 132 (02) 319-325
    CrossrefPubMedGoogle Scholar
  • 9 Rosenberger ES, Toriumi DM. Controversies in revision rhinoplasty. Facial Plast Surg Clin North Am 2016; 24 (03) 337-345
    CrossrefPubMedGoogle Scholar
  • 10 Taştan E, Yücel ÖT, Aydin E, Aydoğan F, Beriat K, Ulusoy MG. The oblique split method: a novel technique for carving costal cartilage grafts. JAMA Facial Plast Surg 2013; 15 (03) 198-203
    CrossrefPubMedGoogle Scholar
  • 11 Robotti E. The role of preoperative planning in secondary rhinoplasty. In: Rohrich R, Ahmad J, eds. Secondary Rhinoplasty by the Global Masters. Boca Raton, FL: Thieme CRC Press; 2016: 1-1816
    Google Scholar
  • 12 Gubisch W. Twenty-five years experience with extracorporeal septoplasty. Facial Plast Surg 2006; 22 (04) 230-239
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Rezaeian F, Gubisch W, Janku D, Haack S. New suturing techniques to reconstruct the keystone area in extracorporeal septoplasty. Plast Reconstr Surg 2016; 138 (02) 374-382
    CrossrefPubMedGoogle Scholar
  • 14 Daniel RK. Rhinoplasty: dorsal grafts and the designer dorsum. Clin Plast Surg 2010; 37 (02) 293-300
    CrossrefPubMedGoogle Scholar
  • 15 Daniel RK, Sajadian A. Secondary rhinoplasty: management of the overresected dorsum. Facial Plast Surg 2012; 28 (04) 417-426
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Robotti E. Shaping the nasal dorsum. HNO 2018; 66 (02) 92-102
    CrossrefPubMedGoogle Scholar
  • 17 Cerkes N. Nasal tip deficiency. Clin Plast Surg 2016; 43 (01) 135-150
    CrossrefPubMedGoogle Scholar
  • 18 Davis RE. Revision of the overresected nasal tip complex. Facial Plast Surg 2012; 28 (04) 427-439
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Ballin AC, Kim H, Chance E, Davis RE. The articulated alar rim graft: reengineering the conventional alar rim graft for improved contour and support. Facial Plast Surg 2016; 32 (04) 384-397
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Gubisch W. Tip refinements in secondary rhinoplasty. In: Gubisch W, ed. Mastering Advanced Rhinoplasty. Cham, Switzerland: Springer; 2017: 635-805
    Google Scholar
  • 21 Kreutzer C, Hoehne J, Gubisch W, Rezaeian F, Haack S. Free diced cartilage: a new application of diced cartilage grafts in primary and secondary rhinoplasty. Plast Reconstr Surg 2017; 140 (03) 461-470
    CrossrefPubMedGoogle Scholar