Reconstructive rhinoplasty: operative revision of patients with previous autologous costal cartilage grafts

Overview

Rib cartilage is used more and more in second time rhinoplasty, and some of those patients still need another operation afterward. This retrospective review looked at third stage rhinoplasty in patients whose previous surgery had used their own rib cartilage. The authors recorded why revision was needed, how often revision was needed again, whether rib cartilage use was planned, and what went wrong around surgery.

Sections of note

• Retrospective review; 46 patients met the inclusion criteria.
• Outcomes tracked were indication for revision, revision rate after the tertiary operation, whether rib grafting was planned, and perioperative events such as infection, structural collapse and scarring requiring further surgery.
• The revision rate after tertiary rhinoplasty by the primary author was 24 percent, 11 of 46 patients.
• Reasons for those further revisions were nasal airway obstruction in 6, dissatisfaction with appearance in 4, and infection in 1.
• Outcomes of the revisions were reported as satisfactory, with no adverse complications requiring further surgery.
• The paper is graded therapeutic level of evidence IV.

What it means for a patient

• Noses previously rebuilt with rib cartilage can be operated on again, but the chance of needing yet another operation is higher than usual.
• Breathing obstruction was the single most common reason for going back, ahead of appearance.
• This is a single surgeon retrospective series with no comparison group and no follow-up length stated, so the 24 percent figure may not apply elsewhere.

Why this paper matters

It quantifies the downstream burden of rib cartilage rhinoplasty, a point rarely made when the graft is first chosen. It does not say which patients are most likely to need revision, or how long the final results hold.

Terms

• Autologous costal cartilage: rib cartilage taken from the patient's own chest.
• Secondary rhinoplasty: a second nose operation after the first.
• Tertiary rhinoplasty: a third nose operation.
• Revision rate: the share of patients who need a further operation.
• Perioperative: the period around the operation, including recovery.