Rib Cartilage Rhinoplasty

Rib cartilage rhinoplasty is a technique that involves taking a segment of your own rib cartilage to create a support structure, lengthen the septum, and shape the bridge and tip of the nose. This method is used when a large and firm amount of cartilage is needed: for revision rhinoplasty, contracted noses, significantly short noses that require extensive lengthening, or when there is a desire to avoid synthetic materials.

Medically reviewed by BS.Ths.CKII Nguyễn Xuân Vũ — BonBoz Clinic

Why is Rib Cartilage Needed?

Septal and auricular cartilage are sufficient for most first-time rhinoplasty cases. However, when a new framework is needed — to lengthen a short nose, correct a contracted nose after multiple surgeries, or when there is no more septal cartilage available — these two sources may lack in quantity and rigidity. Rib cartilage (usually from the 6th or 7th rib) provides a long, straight, and sturdy piece of cartilage to serve as nasal support, extend the septum, and graft the nasal dorsum when synthetic materials are not desired.

True Advantages and Disadvantages

Advantages: Being your own tissue, it does not trigger foreign body reactions, and the risk of infection and visibility is lower than with synthetic materials over the long term. It is suitable for thin skin after multiple surgeries and creates a stable structure. Disadvantages: It adds a 2–3 cm incision under the breast fold (in females, it is located within the breast crease), chest pain for a few days, the risk of cartilage warping over time (which can be minimized by careful shaping, soaking, and observation before placement), longer surgery time, and higher costs; in individuals over 45 years old, the cartilage may calcify, complicating shaping. Processed donor rib cartilage is an alternative option in some cases, with its own advantages and disadvantages — consultation with a doctor is advised.

Indications

For noses that have undergone revision surgery and have exhausted septal/auricular cartilage; for contracted noses that need lengthening; for congenital short upturned noses requiring long support; for individuals with a history of infection or allergy to synthetic materials; for those who prefer entirely autologous tissue. Rib cartilage is not necessary for first-time rhinoplasty in cases with thick skin and sufficient septal cartilage.

Risks to Be Aware Of

At the nose: cartilage warping, visibility on thin skin, partial absorption, prolonged swelling, and prolonged stiffness at the nasal tip. At the chest: pain for a few days, scarring, fluid accumulation, and very rarely, damage to the pleura (the doctor checks during surgery). General risks include infection, numbness, and the need for further adjustments to the results.

At BonBoz

Plastic surgeons only recommend rib cartilage when it is truly necessary — it is not used by default. When utilized, the cartilage is harvested through a short incision in the breast fold, shaped according to balanced principles to minimize warping, soaked and observed before placement, and combined with soft tissue padding if the skin is thin. The examining doctor is the one performing the surgery; the chest incision, duration of swelling, and risks of warping are clearly discussed beforehand.

How is it performed?

Anesthesia. The doctor makes a 2–3 cm incision under the breast fold, retrieves a segment of rib cartilage while preserving the surrounding tissue, checks the pleura, and closes the chest incision. The cartilage is shaped into a nasal tip, with a piece extending the septum and attaching to the dorsum and tip of the nose, ensuring symmetry while observing the curvature. The nose is opened, the framework is reconstructed, grafts are placed, soft tissue padding is added if the skin is thin, and then it is closed and splinted. The procedure lasts 3–4 hours.

Before the procedure

Nose evaluation should include a thorough assessment of the nasal structure and function, along with a review of the surgical history. Breathing function assessment is essential, and preoperative tests must be conducted. For elderly patients, a chest area evaluation may involve ultrasound or imaging to check for calcification if necessary. Patients should discontinue anticoagulants, alcohol, and tobacco at least 2 weeks prior to the procedure.

After the procedure

Nose splint for 7 days; suture removal on day 7. Please limit movement of your arms and chest for the next two weeks. You may experience chest pain, which should decrease after 3–5 days. Expect noticeable swelling of the nose for 2–3 weeks, with the tip of the nose stabilizing in 6–12 months. During follow-up appointments on day 7, and at 1, 3, 6, and 12 months, we will check for any curvature in the cartilage.

Possible risks — your doctor explains them before treatment

Curvature over time can be observed, particularly on thin skin. There may be partial absorption, leading to prolonged swelling and persistent hardness at the tip. Patients might experience pain and scarring in the chest area, along with fluid accumulation. Although pleural damage is very rare, it is a potential risk. Additionally, infection may occur, which could necessitate further adjustments.

Who should NOT have this?

First-time nose lift with a moderate level of complexity, with sufficient septal cartilage available (no need for rib cartilage).
Severe calcification of rib cartilage may be present in elderly patients, necessitating consideration of alternative sources.
Patients with uncontrolled respiratory diseases or internal medical conditions should be evaluated carefully.
Coagulation disorders must be taken into account.
Patients should not expect a quick recovery akin to that of a simple nose lift.

BS.Ths.CKII Nguyễn Xuân Vũ

Department of Plastic and Aesthetic Surgery

Master of Medicine and Pharmacy — Specialist Level I Surgical Resident, Hue University of Medicine and Pharmacy (2014–2017)
Specialist Level II Doctor in Plastic and Aesthetic Surgery
Specialist Level I in Plastic and Aesthetic Surgery — Pham Ngoc Thach University of Medicine; Specialist Level II in Healthcare Management — University of Public Health
Specialty Certificate in Orthopedics and Traumatology and Certificate in Plastic and Aesthetic Surgery (2017)
Medical Practice License No.: 007827/ĐL-CCHN — Issued by Dak Lak Province Department of Health on 04/12/2017
Over 15 years of experience, more than 20,000 surgeries
Specialist Level II Doctor in Plastic and Aesthetic Surgery at Ho Chi Minh City Hospital of Dermatology (2020–present); previously Lead surgeon for major and minor procedures at Sao Han Hospital (2018–2020)
Member of international humanitarian organizations Operation Smile and ReSurge International — performing pro bono reconstructive surgeries for patients with congenital deformities, cleft lip, cleft palate, and ptosis (2022–present)
Affiliated with Alcon Pharmaceutical (USA)
Member of the Korean College of Cosmetic Surgery (KCCS)
Medical Director of BonBoz Clinic

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Frequently asked questions

Does rib cartilage extraction affect health?

Taking a small segment of a rib while preserving the cartilage membrane does not impact long-term respiratory or mobility functions; chest pain may occur in the first few days.

Will there be noticeable scars on the chest?

The incision is 2–3 cm long and located in the crease under the breast (hidden in the breast fold for women), fading over 6–12 months.

Does rib cartilage bend?

There is a risk, which can be minimized by shaping it evenly, soaking and observing before placement, and ensuring proper fixation; the doctor will monitor the patient during follow-up visits.

How long can rib cartilage be preserved?

As it is living tissue, it can last a long time; a small portion may be absorbed or change shape over time.

How does donated rib cartilage differ from autologous cartilage?

It does not require chest surgery, but it is more likely to be absorbed over time and has its own risk of bending and infection; it is suitable when autologous cartilage cannot be obtained.

Is rib cartilage necessary for a first-time rhinoplasty?

Most of the time, no; septal and ear cartilage are sufficient. Rib cartilage is used for complex cases, revisions, or when significant lengthening is needed.

How long is the recovery?

Swelling is prominent for 2–3 weeks, return to work after 10–14 days, and the tip of the nose stabilizes in 6–12 months — longer than simple rhinoplasty.

Can people over 45 use rib cartilage?

Yes, but the cartilage may calcify and be harder to shape; the doctor will evaluate through imaging beforehand and consider other sources if necessary.