Secondary Rhinoplasty surgeries: 2

Why does Dr. Toriumi only use rib cartilage for secondary rhinoplasty surgeries? 

Dr. Dean Toriumi:

After studying over many years the postoperative results in patients for whom I used ear cartilage in their surgery, I noted that there are specific deformities which are very difficult to correct with ear cartilage. There are several reasons for this, including the fact that there is a limited amount of ear cartilage, and ear cartilage is weaker than both septal and rib cartilages. In fact, rib cartilage is by far the strongest cartilage. Some of these deformities difficult to correct with ear cartilage include the short nose or over rotated nose, the severely under-projected nose, noses that require major dorsal augmentation (such as a saddle nose deformity), the severely pinched nose, the severely deviated nose, and patients with severe alar retraction. When I used ear cartilage to correct such deformities, I found that the ear cartilage was relatively weak and tended not to hold up over time, resulting in persistence of the deformity or recurrence of the deformity 2 to 5 years after surgery. Over time, I have found that I am able to better correct such deformities with rib cartilage and see longer-lasting, predictable results.

The patient shown below came to see me with an under projected tip. I performed a secondary rhinoplasty using ear and septal cartilage. In her two year postoperative results, one can see that I was able to project her nasal tip. However, at five years after surgery, her nose shortened (rotated) significantly, leaving her with a short nose and too much nostril show on the frontal view. She requested to have her nose lengthened, as she prefers a longer nose with a convex dorsum. After her revision with rib cartilage, her nose is longer with less nostril show on frontal view and a small dorsal convexity.