Autologous Rib Rhinoplasty — Why Tip Drooping Is Viewed Through Support Structure Before Height

01

Why does the tip descend again after surgery?

Insufficient support structure, weakened cartilage fixation, skin/soft-tissue weight, and tissue weakened by repeated surgery can be causes — so the structure must be checked before simply raising the height again.

• When the structure supporting the tip is insufficient
• When cartilage fixation is weak
• When the weight of skin and soft tissue was not sufficiently considered

In particular, if the support structure is insufficient relative to the cartilage's elasticity or thickness, there are quite a few cases where the tip descends or the form changes over time even if it looks stable initially. In those who have undergone repeated surgeries, the existing cartilage can weaken or support can decrease, further reducing structural stability.

That is why in revision, rather than simply readjusting the tip height, an approach that forms the whole support structure anew matters.

02

In what order was the structure rebuilt in this case?

This case was a patient who visited with the tip gradually descending and the nose line's balance broken down after a first nose surgery. The surgery proceeded in the following order.

• Existing scar tissue cleanup — the scar tissue from the previous surgery was sufficiently organized.
• Tip cartilage repositioning / tip cartilage binding — the tip's form was re-formed.
• Support structure formed between cartilages — stability was raised so the tip would not easily descend over time.

In revision, material choice that can keep the tip stable for a long time is also an important element. Autologous rib cartilage can secure sufficient length and strength, helping build support structure, and is often used to reinforce a weakened existing structure. For the same reason, cases with repeated tip drooping or multiple surgical histories often plan a stable structure with autologous rib rhinoplasty. At our clinic, the method of processing harvested rib cartilage into fine particles and fabricating it into a form fitting the nasal structure is called RIBFIT™. Details can be checked in autologous rib RIBFIT™.

As a result, the drooping-looking tip was naturally organized — a case planned so that a stable nose line could be maintained over time.

03

What options are there if you don't want silicone?

The second case underwent rhinoplasty after double-jaw surgery. She had a history of tip cartilage binding, but the cartilage was not sufficiently gathered; the whole nose was tilted asymmetrically, and the bridge height was generally lacking.

Because this patient did not want an implant, the plan went in the direction of using rib cartilage and a diced autologous rib implant.

Quite a few people feel burdened by using silicone, and the diced autologous rib implant is one of the methods that can substitute for it. On the other hand, with some previously common materials, changes could appear over time as absorption progressed — height decreasing or the tip looking dull again.

After surgery, as the nose's balance was organized, the feeling that the mouth protruded relatively forward was also relieved together, and a natural change in the whole profile line could be confirmed. Before-and-after changes by case can be seen in the before-and-after photos.

04

Summary — what is rebuilt is structure, not height

When re-operating a nose whose tip has descended over time, supplementing only the height can repeat the same change. The key of this case was checking why the structure supporting the tip had weakened, then rebuilding in order — scar tissue cleanup, cartilage repositioning and binding, and support structure formation. Autologous rib cartilage and the diced autologous rib implant are material options for making that structure.

If you are curious which cause your tip drooping is closest to, your condition can be checked directly in a 1:1 video consultation.