Do I Need a Rib Graft for Rhinoplasty?

Not every rhinoplasty requires a rib graft — There are certain situations where there is not enough cartilage to perform the case safely or the cartilage is poor quality and rib cartilage is the safest and most reliable option for long-term stability. Here’s how I decide.

When You Don’t Need a Rib Graft

Most primary rhinoplasty patients do not need rib cartilage. Septal cartilage is usually enough for:

  • tip refinement

  • the majority of the surgery including straightening the nose and preserving length.

For these cases, septal cartilage provides excellent strength and contour.

When You Do Need a Rib Graft

I recommend rib cartilage when:

  • you have had previous rhinoplasty and septal cartilage is gone and:

  • the nose is collapsed or pinched

  • the bridge needs significant augmentation (for primary surgeries too)

  • major support must be rebuilt

  • the septum is too weak to support grafting

  • a saddle nose deformity is present

Rib cartilage is strong, abundant, and ideal for reconstructing difficult noses.

What About the Harvest?

I take ~100 ribs per year. With modern technique:

  • incision is ≤1.5 cm

  • nerve blocks make recovery easier

  • no cautery reduces trauma

  • risk of pneumothorax is extremely low (0% in my hands)

  • graft quality is superior

Bottom Line

You only need a rib graft if your anatomy, prior surgery, or goals require structural rebuilding. Most primary rhinoplasty cases don’t need one, but revision or complex cases are often safer and more predictable with rib cartilage.

ARI HYMAN