Rhinoplasty and rib grafts: evolving a flexible operative technique.

A flexible operative technique for utilizing rib grafts in difficult rhinoplasty and nasal reconstruction cases requiring support is presented. An osseocartilaginous rib segment is used for dorsal contour or support, while a rigid cartilaginous strut provides for both tip projection and columellar contour. The bone is contoured extensively, while the cartilage is altered minimally. An open approach is employed. A bony fixation platform is established by radix reduction followed by bony fixation with ultramicroscrews. Distally, the grafts are united when nasal lengthening or total support is required; otherwise, the grafts are juxtaposed to allow lateral movement. The operative technique and technical difficulties are described in detail based on experience in 14 patients.