Introduction

Rhinoplasty, commonly known as a "nose job," is a highly sought - after plastic surgery procedure that enhances facial harmony and the proportions of the nose. Costal cartilage transplantation in rhinoplasty is a specialized technique, especially useful in cases where large amounts of cartilage are required, such as revision rhinoplasty or severe saddle nose deformity. In New York City, a hub of plastic surgery, there are numerous experts in costal cartilage transplantation rhinoplasty. This article aims to provide a comprehensive comparison, including rankings of experts and a collection of plastic surgery before - and - after pictures.

Importance of Rhinoplasty and Costal Cartilage Transplantation

Rhinoplasty can significantly improve a person's self - confidence and facial aesthetics. A well - performed rhinoplasty can correct functional issues such as breathing problems and reshape the nose to better suit the individual's facial features. Costal cartilage, obtained from the patient's rib cage, is often preferred in certain rhinoplasty cases because it provides a large and strong source of cartilage that can be shaped to meet the specific needs of the nose reconstruction. However, it also has its own set of challenges and considerations, such as donor - site morbidity and the risk of warping or resorption.

Understanding Rhinoplasty

What is Rhinoplasty?

Rhinoplasty is a surgical procedure that alters the shape, size, or functionality of the nose. It can be either cosmetic, aiming to improve the appearance of the nose, or functional, addressing breathing problems. The American Society of Plastic Surgeons notes that rhinoplasty enhances facial harmony and the proportions of the nose. There are two main types of rhinoplasty: open and closed. Open rhinoplasty involves making an incision across the columella (the tissue between the nostrils), which allows the surgeon better access to the nasal structures. Closed rhinoplasty, on the other hand, is performed through incisions inside the nostrils, leaving no external scars.

Costal Cartilage in Rhinoplasty

Costal cartilage is one of the key materials used in rhinoplasty. As Fred G Fedok's study published in Costal Cartilage Grafts in Rhinoplasty (PubMed ID: 26616708) states, in many situations like revision rhinoplasty or when patients have a small amount of native septal cartilage, costal cartilage from the rib cage can be a valuable alternative. It offers an abundant supply that can be carved into various necessary grafts for procedures like augmentation, tip refinement, or dorsal reconstruction.

There are two types of costal cartilage commonly considered in rhinoplasty: autologous costal cartilage (ACC) and irradiated homologous costal cartilage (IHCC). A study by Jee Hye Wee et al. (JAMA Facial Plast Surg. 2017 May; 19(3): 183 – 188) compared the use of these two types. The researchers found that autologous costal cartilage showed superior aesthetic satisfaction and less frequent notable resorption compared to irradiated homologous costal cartilage. Patients using ACC had a 73% very - satisfied rate in aesthetic evaluations, while those using IHCC had only a 30% very - satisfied rate. The rate of notable resorption was also much lower in the ACC group (3%) compared to the IHCC group (30%).

Top Experts in Costal Cartilage Transplantation Rhinoplasty in New York City

Newsweek Rankings and Insights

Newsweek has released several rankings of America's best plastic surgeons, which include those specializing in rhinoplasty. In the 2024 ranking, for rhinoplasty, many experts from New York were recognized. For example, Alan Matarasso, MD, FACS; Sherrell J. Aston, MD; Daniel C. Baker, MD; Richard G. Reish, MD, FACS; and Eduardo D. Rodriguez, MD, DDS were among the top - rated plastic surgeons in New York. These rankings are based on a comprehensive survey of thousands of medical experts. The methodology included factors such as in - state and out - of - state recommendations from plastic surgery professionals, quality of care assessments (including consultation, complications, follow - up, and outcome), and relevant certifications.

In 2021, Andrew Jacono, MD, FACS was also highly ranked. He is the surgical director of the New York Center for Facial Plastic and Laser Surgery. Jacono is known for his unique and innovative surgical approach. He has pioneered less - invasive techniques that avoid breaking the nose and removing excessive cartilage, aiming for natural - looking results. He is also renowned for his work in ethnic rhinoplasty, preserving ethnic identity while achieving beautiful nasal definitions.

Other Prominent Surgeons

Richard Reish, MD, FACS, is another well - known name in New York City. He has been featured in multiple platforms showcasing rhinoplasty before - and - after photos by the American Society of Plastic Surgeons. His extensive experience and successful surgeries have earned him a reputation among patients seeking costal cartilage transplantation rhinoplasty.

Comparative Picture Collection

Before - and - After Benefits

Before - and - after pictures are invaluable tools for patients considering costal cartilage transplantation rhinoplasty. They provide a clear visualization of the potential results of the surgery. For example, the Mount Sinai - New York offers a rhinoplasty before - and - after gallery. Looking at these pictures, patients can see how a surgeon can transform the shape of the nose, improve nasal symmetry, reduce dorsal humps, refine nasal tips, and correct other nasal irregularities.

When comparing the work of different surgeons, patients can analyze the naturalness of the results, the quality of the scarring (if any), and the overall improvement in facial harmony. Surgeons like Andrew Jacono have shared numerous before - and - after photos of his patients. One patient, a young Latina woman, was unhappy with her dorsal hump and nasal tip. After the surgery, her tip was refined, and the dorsal hump was reduced, resulting in a more balanced and aesthetically pleasing appearance.

Analysis of Different Surgeons' Results

By studying the before - and - after pictures of various New York City experts, patients can notice differences in surgical styles. Some surgeons may have a more conservative approach, making subtle changes to the nose, while others may be more aggressive in achieving a more dramatic transformation. For instance, in cases where costal cartilage is used for augmentation, the thickness and contour of the graft can vary between surgeons, leading to different final nose shapes.

Another aspect to consider is the treatment of specific ethnic nasal features. Surgeons like Jacono, who are experts in ethnic rhinoplasty, take into account the unique characteristics of different ethnic groups to preserve identity while enhancing aesthetics. In contrast, some general rhinoplasty surgeons may have a more one - size - fits - all approach, which may not be as suitable for patients with specific ethnic nasal characteristics.

Costal Cartilage Transplantation Procedure

Harvesting Costal Cartilage

The process of harvesting costal cartilage is a critical step in costal cartilage transplantation rhinoplasty. As described in the literature, for autologous costal cartilage, rib cartilage (usually 4 - 5 cm) is harvested from the right chest. The central portion of the rib is typically used, with the periphery symmetrically carved out using a No. 10 blade. The cartilage is then shaped into a boat - shaped graft with a slight concavity on the undersurface to match the contour of the nasal dorsum and avoid dead spaces.

Before implantation, the cartilage is submerged in warm saline 2 or 3 times for at least 10 minutes between carvings to minimize warping. It is also soaked in an antibiotic solution, such as clindamycin phosphate, to prevent infection. The entire harvesting process requires precision and skill to minimize donor - site morbidity, such as pneumothorax, postoperative pain, and scarring.

Implantation in Rhinoplasty

Once the costal cartilage is harvested and prepared, it is implanted into the nose. A large graft is usually inserted for dorsal augmentation, and its size can vary depending on the patient's needs. The length of the dorsal graft is typically between 30 to 40 mm, the thickness is 4 to 6 mm, and the width is 8 to 10 mm. If the initial dorsal augmentation is not satisfactory, thin graft layers may be stacked underneath the dorsal graft to achieve the desired dorsal height or a better fit. The graft is then sutured to the underlying framework to prevent slippage or movement.

Complications and Considerations

Complications Associated with Costal Cartilage Transplantation

Costal cartilage transplantation rhinoplasty is not without risks. One of the most significant concerns is resorption. The study by Jee Hye Wee et al. found that the rate of notable resorption was higher in patients using irradiated homologous costal cartilage (30%) compared to those using autologous costal cartilage (3%). Resorption can lead to a change in the shape of the nose over time, reducing the long - term effectiveness of the surgery.

Warping is another complication that can occur. Although the warping rates between autologous costal cartilage (13%) and irradiated homologous costal cartilage (10%) were not significantly different in the study, it can still cause an imbalance in the nasal shape. Infection is also a risk, although the rates were relatively low in both the ACC and IHCC groups, with 5% and 5% respectively. Donor - site morbidity, such as hypertrophic chest scars and pneumothorax, is more commonly associated with autologous costal cartilage harvesting.

Considerations for Patients

Patients considering costal cartilage transplantation rhinoplasty should have a thorough consultation with their surgeon. They should discuss their goals, expectations, and any concerns they may have regarding the procedure and its potential complications. It is also important to choose a surgeon with extensive experience in costal cartilage transplantation, as the success of the surgery depends largely on the surgeon's skills and expertise. Patients should review the surgeon's before - and - after pictures, patient testimonials, and professional rankings to make an informed decision.

Conclusion

In conclusion, costal cartilage transplantation rhinoplasty is a complex and specialized surgical procedure that can offer significant aesthetic and functional benefits. In New York City, there are many top - notch experts in this field, as recognized by rankings such as those from Newsweek. The comparative picture collection of plastic surgery can help patients visualize the potential results and compare the work of different surgeons. Understanding the procedure, its associated complications, and carefully selecting a surgeon are crucial steps for patients considering this type of rhinoplasty.

If you are considering costal cartilage transplantation rhinoplasty, we encourage you to explore more information about the surgeons mentioned in this article. Review their before - and - after galleries, read patient reviews, and schedule consultations to discuss your specific needs. Don't hesitate to share this article with others who may be interested in learning more about this specialized plastic surgery procedure.