Costal Cartilage Harvest

The Problem

A need for autologous cartilage sufficient in strength and in quantity to manage both complex primary and secondary nasal deformities.

The Background

Cartilage grafting is often necessary to achieve the aesthetic and functional goals in rhinoplasty. Septal cartilage is an ideal material but is often in short supply. Auricular cartilage may be used, but it is relatively weak and irregular in contour. In contradistinction, costal cartilage is abundant and strong, but meticulous harvest and thoughtful application are required to produce reliable and consistent results.

Aesthetic and functional rhinoplasty has transitioned from a reductive to a structural operation using cartilage grafts to contour the nose and improve nasal function. Structural grafts are resistant to natural forces including tissue contraction, paranasal muscle activity, and forces owing to gravity and aging. In most primary rhinoplasty cases, there is adequate septal cartilage to perform any necessary grafting maneuvers. In secondary rhinoplasty, surgeons may need to access a secondary site to procure enough cartilage for grafting. In this chapter we offer our techniques for harvesting and mitigating the risks associated with rib cartilage. Additionally, we describe our preference for the seventh rib, which maximizes the amount of usable straight cartilage while minimizing the risk of pneumothorax. Contemporary techniques have created a safe and reliable approach to the use of costal cartilage in rhinoplasty.