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Reasons for Curving in Rib Cartilage Rhinoplasty and Its Control

Someone ask about the reason for curving in rib cartilage rhinoplasty and methods to control, "I am interested in have a primary rhinoplasty using rib cartilage. I heard that curving is an issue for a lot of male patients, and what is the reason for this?" 
"Do you use k-wire? I think the combination of the use of rib cartilage with a wire will be a strong preventative measure. Do you fixate the graft on the cephalic end with a percutaneous k-wire?"
 
 

The reasons for curving in rib cartilage rhinoplasty

Yes, curving is still an issue in rib cartilage rhinoplasty for both doctors and patients, women and men.
Usually, the graft for rib cartilage rhinoplasty is harvested from the 6th or 7th or 8th rib cartilage of the thorax. The shape of thorax is not the same for all of us, for example barrel-shaped, oblate, and pigeon-breasted and so on, so the length, size and shape of rib cartilage is quite different between individuals. Some are very straight, while others may be curving together with warping. This shows the rib cartilage is curving in itself by nature.
 
 
 

The thorax skeleton   from website
 
Moreover, even the same rib cartilage, the curving rate is very different from the outside which is called cortex, and inside which is called medulla. Many study clearly demonstrated the principle that rib cartilage is less prone to later curving and warping when obtained from the center of the segment. In a word, the cortex has higher curving rate than medulla. 
Thus the curving rate of rib cartilage rhinoplasty is related with individual physical developments and it is generally believed to be 5% on average.  
 
If some patients demand large volume of dorsal graft, sometimes it is difficult to carve out ideal dorsal graft from limited medulla of cartilage, and we have to use the cortex part. As a result, the posibility of curving increased. If this is your most concerned thing, you may also consider a Goretex or silicone graft on nasal bridge. However, it must be understood that even if chooses Goretex or silicone graft on nasal bridge, the rate of curving does exist.
 

The controls for curving in rib cartilage rhinoplasty

I can use Kirschner wire(K-wire) to prevent curving if your dorsal graft design is thick enough and you don't care about a metal object under Xray. But k-wire is inserted into the graft during the surgery. Then the graft is implanted into the nasal dorsum. So there is no such a percutaneous step to fix the graft. By the way, percutaneous k-wire is applied for finger bone fracture.
Although there are occasional cases of K-wire rejected through the skin clinically, it will leave no pinhole stains on the skin. 
 

Another of warping preventative method--transversal carving
 
 
Some Long-term postoperative result sharing:
 

[Video] 1 Month Postop.Result of Autologous Rhinoplasty

 

Male Patient Seeking “Perfect Nose”

 

Office lady's rib cartilage rhinoplasty 8 month later

 

Autologous rib (costal) cartilage for our nurse's rhinoplasty