Doctor's Column

One of the biggest concerns for patients facing revision rhinoplasty is, "Which cartilage should I use?" It is well known that autologous rib cartilage is the strongest and most stable, but depending on the situation, using rib cartilage can be difficult or reluctant. In this case, which cartilage should you choose? Based on the criteria for cartilage materials selected in actual clinical practice and surgical cases by Director Kim Sung-hoon, this post explains in detail the pros and cons of donated rib cartilage, autologous septal cartilage, and autologous ear cartilage from an anatomical and functional perspective. Beyond simple comparison, we provide the reasons why a certain cartilage is best in certain situations along with research-based evidence.

Dr. Kim Sung-hoon, Director of SH Plastic Surgery. Face Designer Dr. Kim Sung-hoon

Hello, I am Dr. Kim Sung-hoon, Director of SH Plastic Surgery and Face Designer.

In the last blog post, I talked about 'Why autologous rib cartilage is the best choice in revision rhinoplasty.'

This is because it shows superiority in various factors such as strength, retention, and engraftment rate, and especially, the most stable results can be expected in revision surgeries.

However, when consulting with numerous patients I meet in the consultation room, I realize one clear fact once again.

That is, "No matter how good a material is, it cannot be applied equally to everyone."

Some worry about scars, some about age and pain, and others due to past medical conditions,

Autologous rib cartilage can be burdensome.

And actually, for those people,

In that case, a different path (using different materials) is needed.

"Director, I want to have surgery with rib cartilage... but I'm so worried about the scar."

"I'm in my 60s, so harvesting from my rib is a bit scary."

"I've been working out for a long time, and I heard my ribs aren't in good condition."

Many people considering autologous rib cartilage rhinoplasty say this.

In fact, autologous rib cartilage has the highest strength and stable results, but it cannot be applied to all patients.

Other alternatives are needed for those who are sensitive to scars, have had pleurisy or costochondritis in the past, or are elderly or have high pain sensitivity.

If so, what is the best choice if rib cartilage is not used?

From now on, I will explain those alternatives one by one.

Types and Criteria of Rhinoplasty Materials You Must Know Before Surgery

First, cartilage materials used for nasal tip plasty are classified as follows.

"The rule of thumb is not to use artificial materials for the nasal tip."

Director of SH Plastic Surgery, Face Designer Dr. Kim Sung-hoon

[CASE 1] When autologous rib cartilage cannot be used

Autologous rib cartilage is ideal because it is the hardest, has a low absorption rate, and lasts a long time without deformation even in revision surgery. However, its use is limited in the following cases.

History of previous rib cartilage harvesting

Calcification in the rib cartilage or thin ribs (CT confirmation required)

Patients who are sensitive to pain or elderly

Occupations sensitive to scars (models, actors, etc.)

When it is judged difficult to maintain the fixation of rib cartilage due to high activity levels, such as in athletes

In this case, alternative cartilage is needed.

[CASE 2] Donated Costal Cartilage – An alternative without tissue rejection

Advantages:

Reduced surgery time (omits the rib harvesting process)

No scarring (no need for additional incisions)

Controlled safety as a processed commercial product

Disadvantages:

Cannot verify donor's age and bone density → possibility of absorption

Risk of absorption ↑ in highly active patients

Slight decrease in elasticity after a certain period

Case:

“A male patient in his 50s had surgery with Medpor® at another hospital and was referred for revision surgery due to inflammation.

Since he did not want a chest scar, it was reconstructed using donated costal cartilage, and it has been stably maintained for 2 years.”

[CASE 3] Autologous Septal Cartilage – Harvested from inside the nose, natural appearance ↑

Advantages:

Harvested from inside the nose → NO scars

Short and simple surgery time

Good elasticity, advantageous for creating natural lines

Disadvantages:

Small harvestable amount

Potential to warp if nasal septal deviation is present

Weak support if warped or thin

Case:

“A female in her 20s wanted correction of only the nasal tip after incisional double eyelid surgery. Because her tissue was thin, sufficient height and shape could be achieved using only the septum. No scarring and fast recovery.”

[CASE 4] Autologous Ear Cartilage – The softest and most flexible material

Advantages:

The softest cartilage

Allows natural movement, such as making a 'pig nose'

High tissue engraftment rate and minimal scarring

Disadvantages:

Weak structural support → unsuitable for nose elevation

Left and right cartilages often differ in shape and are curved

More suitable as a secondary material rather than used alone

Case:

“Ear cartilage is mainly used to add 'naturalness'. It is utilized in a supplementary manner, such as for nostril expansion or columellar reinforcement.”

What is Donated Rib Cartilage: Pros and Cons

Donated rib cartilage literally refers to a medical grafting material

packaged after sterilizing another person's rib cartilage in advance and removing all cells.

Since the cells are not alive, there is no graft rejection reaction.

This means the body will never recognize it as "Wait, this isn't mine."

The biggest advantage of this material is that "you do not have to harvest your own rib cartilage."

In other words, it leaves no scars on the chest, and without the need for additional surgery to harvest rib cartilage,

the main procedure can begin right away, leading to shorter operation times and faster recovery.

The cost of donated rib cartilage is also relatively cheaper.

There are also disadvantages.

First, the donor's age cannot be known.

Since older cartilage is more likely to be absorbed easily,

there are cases where the tip of the nose may droop over time.

Simply put, if the cartilage is not firm, it cannot hold up for a long time.

Second, the patient's own constitution also plays a role.

In particular, for people with a high metabolic rate, like athletes,

that is, individuals whose bodies recover or regenerate quickly,

the cartilage may be absorbed rapidly regardless of the donor's age.

In such cases, the tip of the nose can drop faster than anticipated.

Dr. Seong-hoon Kim's Insights

I always explain this to patients during detailed consultations:

"Donated rib cartilage is certainly a good alternative, but the decision must be made by carefully considering each individual case."

Especially in revision surgeries where the retention of the nasal tip is paramount,

autologous rib cartilage should ideally be the first priority,

and if that is difficult, donated rib cartilage should be used with careful design.

The key is that "there is a reason for every material."

It is not merely about what to insert, but an anatomical design tailored to one's own structure is what truly matters.

I always comprehensively analyze the patient's medical history, skin thickness, cartilage condition, and past surgical experience to suggest the best combination.

I do not unconditionally insist only on rib cartilage, nor do I blindly compromise with artificial implants.

Understanding the structure of one's own body and designing a surgery that fits one's face—that is the true philosophy of a facial designer.

In the next post, we will cover what artificial materials used in the nasal tip, such as Medpor®, Mesh, and silicone, are.

I would like to talk about how to perform revision surgery for side effects caused by rhinoplasty using artificial materials.

A must-watch Q&A video before getting a #rhinoplasty! Resolving all your questions, even about #revisionrhinoplasty! [#SHPlasticSurgery] - YouTube

SH Plastic Surgery Clinic