Rib grafting in the nose: Everything you need to know
Updated on • Reviewed by Dr. Gustavo Sordo, plastic surgeon
When rhinoplasty requires reconstructing a weakened nasal structure, correcting a complex deformity, or revising a previous surgery, the cartilage available in the nose or ear is often insufficient. In these cases, the surgeon may use rib cartilage, harvested from one of the patient's own ribs, as graft material.
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What is a rib graft in the nose?
Where does costal cartilage come from?
The costal cartilage is obtained from a small portion of one of the patient's own ribs, usually from the lower chest area, where its extraction is safer and less visible.
What function does it perform within the nasal structure?
Once transplanted to the nose, this cartilage provides structural support, allowing the reconstruction or reinforcement of areas where the nasal skeleton has become weakened or insufficient.
Autologous grafting and synthetic materials
Since it comes from the patient themselves, it is considered an autologous graft, which reduces the risk of rejection compared to other alternatives such as synthetic or tissue bank materials, which are less commonly used in rhinoplasty due to their own limitations.
When is rib cartilage used in rhinoplasty?
Rib grafting is not a first-line technique: we use it when there is insufficient septal cartilage , which in practice means secondary rhinoplasties, traumatic noses, and noses that require significant dorsal augmentation, such as many flat noses or noses with Asian features. The key to its success lies in how it is prepared: we laminate and sculpt it in a balanced way, and we incorporate techniques such as the oblique split described by Taştan, precisely to reduce the risk of the graft curving over time (Taştan et al., 2013, JAMA Facial Plast Surg ).
In these surgeries, I use hyperbaric oxygen therapy postoperatively, and here it's important to distinguish between two things. Its role is documented when tissues have compromised perfusion: skin at risk, flaps, composite grafts, and revision surgery on a previously operated nose, where pre-existing fibrosis limits blood flow. This is what Toriumi's review (2026) , dedicated to secondary rhinoplasty, and Kerolus and Nassif's protocol (2019) for compromised nasal skin cover. What I add is indicating it also to promote the integration of the costal cartilage graft itself, and the literature doesn't cover this: it addresses skin and flaps, not the graft. This second part is based on my own observational criteria, based on what I see in my patients, and I prefer to state it this way rather than present it as established practice. The usual protocol in my practice is five sessions, starting on the same day as the surgery, within a broader protocol that begins before the operating room. Dr. Gustavo Sordo · Member No. 282858125
Secondary or revision rhinoplasties
It is especially common in secondary rhinoplasties, when a previous surgery has left the nasal structure weakened or with insufficient cartilage for a new intervention.
Noses with weak support or lack of septal cartilage
When the nasal septum cartilage, the usual source of grafts, is insufficient or has already been used in previous surgeries, rib cartilage becomes the most consistent alternative.
Congenital or post-traumatic deformities
Certain deformities present from birth, or resulting from major trauma, may require an amount of cartilage that only the rib can provide.
Reconstruction of the nasal dorsum and tip
Costal cartilage allows reconstruction of both the dorsum and the nasal tip in cases where it is necessary to recover a projection or height that has been lost.
Functional problems associated with nasal valve collapse
It is also used to reinforce the nasal valve when its collapse causes breathing difficulties, combining the aesthetic objective with functional improvement.
Ethnic nose and Latin nose
In patients with ethnic features or Latin-looking noses , the nose often presents specific structural characteristics: thicker skin, weaker cartilage, or less tip projection, which frequently require more support material than the septal cartilage can provide. The costal cartilage, due to its consistency and volume, allows for the precise work necessary to redefine the nasal structure while respecting the patient's unique features and achieving a harmonious result with the rest of the face.
You may also be interested in: types of noses.
Types of Cartilage
Nasal septum cartilage
It is the first option in most primary rhinoplasties, as it is tissue close to the area to be operated on, although its quantity is limited.
Ear cartilage
It offers an alternative when the septal bone is insufficient, although its curved shape and lower consistency limit its use in certain types of reconstructions.
Rib cartilage
It provides the largest amount of tissue available, with a firm consistency that makes it ideal for complex structural reconstructions.
How the surgeon chooses the donor area
The choice depends on the amount of cartilage needed, the type of defect to be corrected, and the availability of tissue after previous surgeries, always assessed on an individual basis.
How is the graft obtained?
Location and size of the incision
The incision to extract the cartilage is made on the selected costal area, with a size adjusted to the amount of tissue that needs to be obtained.
Extraction of a portion of cartilage
A portion of costal cartilage is precisely extracted, preserving the integrity of the surrounding structures and minimizing the impact on the donor area.
Carving and preparation of the graft
Once extracted, the cartilage is carved and prepared into different pieces according to the function it will perform within the planned nasal reconstruction.
Closing and care of the donor area
The donor area is carefully closed in layers, following a specific protocol to minimize discomfort and promote good thoracic healing.
How to place the graft
Grafts to lift or reconstruct the back
Certain pieces of cartilage are used to raise or reconstruct the nasal dorsum when it presents a depression or a loss of structure.
Grafts to reinforce and project the tip
Other pieces are placed on the nasal tip to reinforce its support and achieve the desired projection.
Septal extension grafts
Septal extension grafts are attached to the existing septum to lengthen or stabilize the central structure of the nose.
Spreader grafts for support and respiratory function
These grafts are placed on either side of the septum to widen the internal nasal valve, improving both aesthetics and respiratory function.
Camouflage grafts and correction of asymmetries
Small pieces of cartilage can also be used as camouflage, disguising bone irregularities or asymmetries visible under the skin.
Advantages of costal cartilage in rhinoplasty
More fabric available
Unlike septal or auricular cartilage, the rib offers a much larger amount of tissue, essential in extensive reconstructions.
Strength and support capacity
Its firm consistency makes it the most suitable material when a solid and durable structural support is needed.
Versatility for complex reconstructions
It can be carved into different shapes and sizes, adapting to virtually any reconstructive need within the nose.
Integration by using the patient's own tissue
Because it comes from the body itself, it integrates more predictably than synthetic materials, reducing the risk of adverse reactions.
Lasting structural results
When handled correctly, it offers stable and long-lasting structural results in the long term.
Risks and possible complications
Cartilage warping or deformation
The costal cartilage may have a tendency to curve over time, a phenomenon known as warping, which experienced surgeons try to minimize with specific carving techniques.
Infection, displacement, or reabsorption
As with any graft, there is a risk, albeit low, of infection, displacement of the material, or partial reabsorption of the implanted tissue.
Irregularities or asymmetries
Small irregularities or asymmetries may appear visible under the skin, especially in patients with very thin skin.
Pain, scarring, or alterations in the donor area
The chest area where the cartilage was removed may present pain, a visible scar, or altered sensation during the recovery process.
Pneumothorax as an uncommon complication
Pneumothorax, that is, the entry of air into the pleural space, is a possible but infrequent complication associated with the removal of costal cartilage.
Need for a new intervention
In some cases, further intervention may be necessary to correct some of these complications or adjust the final result.
How is recovery
First few days after surgery
The first few days usually involve swelling in both the nose and the operated chest area, requiring relative rest.
Nose and donor area care
Both areas require specific care as indicated by the medical team, including monitoring of healing and pain control.
Expected inflammation and discomfort
Some degree of inflammation and chest discomfort is to be expected, especially when breathing deeply or coughing during the first few days.
When to resume work and exercise
The return to work usually occurs around one or two weeks later, while intense physical exercise is resumed more gradually, as indicated by the surgeon.
Evolution of the thoracic scar
The scar in the rib area tends to fade over time, following a maturation process similar to that of any other surgical scar.
When are the final results seen?
Visible changes during the first few weeks
During the first few weeks, noticeable changes can already be seen, although residual inflammation still affects the final appearance.
Evolution of nasal inflammation
Nasal swelling tends to gradually decrease over the months following the procedure.
Graft adaptation and integration
The graft needs a period of adaptation and integration in its new location before showing its final form.
Medium and long-term monitoring
Medium and long-term monitoring allows for assessing the stability of the result and detecting any changes in the reconstructed structure in a timely manner.
Who is a good candidate for this procedure?
Assessment of nasal structure and function
The indication is based on a detailed assessment of both the structure and respiratory function of the patient's nose.
General health status
The patient's general health condition must allow for both nasal surgery and costal cartilage removal to be carried out safely.
Realistic expectations
It is essential that the patient understands the true scope of the reconstruction, especially in complex revision cases.
Importance of choosing a surgeon with experience in complex rhinoplasties
This type of procedure requires a surgeon with specific experience in structural rhinoplasty and in the handling of rib grafts.
Rhinoplasty with rib graft at Dr. Gustavo Sordo's clinic
When a nose presents with insufficient support, complex deformities, or the aftereffects of previous surgery, the treatment plan must be tailored to its structure and function. At the Plastic Surgery Clinic in Madrid of Dr. Gustavo Sordo, a plastic surgeon specializing in rhinoplasty techniques , ultrasonic rhinoplasty , and ethnic rhinoplasty, each patient individually assesses when it is necessary to use rib cartilage to reconstruct and reinforce the nose. Request a consultation to learn which technique can offer you a natural, stable, and functional result.
Dr. Sordo specializes in rhinoplasty , and with over 20 years of experience, he is dedicated to providing personalized solutions for each patient, with both an aesthetic and functional focus. We recommend you take a look at all his before and after rhinoplasty cases.
Frequently Asked Questions (FAQs)
Does it hurt to remove cartilage from a rib?
The extraction is performed under anesthesia, so there is no pain during the procedure; in the postoperative period there may be discomfort that is controlled with the medication indicated by the medical team.
Is there a scar left on the chest?
Yes, a small scar remains in the area where the incision was made, which usually fades considerably over the months.
Can costal cartilage become deformed over time?
There is a certain natural tendency of the costal cartilage to curve, a phenomenon that experienced surgeons minimize through specific carving and placement techniques.
Can the body reject a cartilage graft made from its own tissue?
Since it comes from the patient's own body, the risk of rejection is very low compared to external materials, although other complications such as partial reabsorption may occur.
How long does recovery last?
Initial recovery usually lasts between one and two weeks, while the final result is fully appreciated after several months.
In what cases is it preferable to ear or septum cartilage?
It is preferred when a larger amount of tissue or a firmer consistency is needed than can be provided by septal or auricular cartilage, especially in complex revisions.
Are the results permanent?
Yes, since it is a structural reconstruction using the patient's own tissue, the results are permanent, although the final shape depends on a correct surgical technique.
Conclusion
Rib cartilage grafting is one of the most versatile and resilient tools available in structural rhinoplasty , especially indicated in complex revisions and reconstructions where the septal or auricular cartilage is insufficient. Understanding how it is obtained, how it is placed, and what risks it entails allows surgeons to approach this type of surgery with complete information. Choosing a surgeon with specific experience in handling this type of graft is crucial for achieving a natural, stable, and functional long-term result.