Is Rib Removal Needed in Primary Rhinoplasty?

Usually not. In a first (primary) rhinoplasty, most surgeons rely on cartilage from inside your nose. Rib cartilage is a back-up for bigger structural needs, and it is a different operation from “removing a rib”. If someone tells you rib cartilage is part of your plan, you are entitled to a clear explanation.

Key takeaways

• In most first-time rhinoplasties, surgeons use cartilage from the nose itself; ear cartilage is occasional and rib cartilage is rare.
• 'Rib removal' means harvesting a piece of rib cartilage, not removing a rib bone.
• If a surgeon plans rib cartilage, fair questions are why it is needed, where the graft will come from and what donor-site problems to expect.

What does “rib removal” actually mean?

Rhinoplasty grafts are most often cartilage, a firm but flexible tissue, rather than bone. The American Society of Plastic Surgeons (ASPS) says surgeons may add cartilage grafts that are most often taken from the septum, the cartilage wall between the nostrils, that cartilage from the ear is occasionally used, and that rib cartilage is used rarely. For the full comparison of septum, ear, rib and donor cartilage, see nasal cartilage grafts.

Taking rib cartilage means a small incision on the chest and removing a portion of cartilage from the rib cage. A 2024 review of the technique for secondary rhinoplasty, Bagunaid and colleagues, describes harvesting from the seventh rib under general anesthesia, and also describes alternatives that aim to reduce complications, such as using the 10th rib or donated, fresh frozen rib cartilage as a graft.

When is rib cartilage used?

When there is not enough other cartilage, or a strong, large graft is needed. Bagunaid and colleagues describe septal cartilage as usually the first option, with rib cartilage considered when septal cartilage is insufficient, which is why it features in secondary (revision) surgery, where earlier operations may have limited what is left.

It is not limited to revisions. A 2024 case series in Plastic and Reconstructive Surgery, Novak and colleagues, reviewed 638 consecutive primary rhinoplasties by one surgeon and found that 30 (4.7%) needed a rib graft, and in that series it was fresh frozen donated rib cartilage. All used a septal extension graft, a strut that lengthens the septum to shape the tip. The authors linked this need to thick skin, a weak cartilage framework or a history of nasal trauma, and noted differences by patient background. One surgeon’s practice is not a general rate, but it shows why the answer is “not usually, but sometimes”.

Our guides to ear cartilage grafts, donor cartilage and revision rhinoplasty cover the other sources.

What risks do studies report?

Two systematic reviews give a sense of the range, with caveats about small numbers.

The Wee authors concluded that long-term complications and donor-site problems were low, with warping and raised chest scarring relatively higher. They flagged that few studies and inconsistent definitions limit the findings, and their confidence intervals are wide (for example, 6.2% to 24.2% for revision surgery). Varadharajan and colleagues concluded that the operation is safe but has not-insignificant rates of minor recipient-site problems such as warping.

The British Association of Aesthetic Plastic Surgeons also notes that if bone, cartilage or skin is taken from another part of the body, this leaves a scar that may be noticeable. Both reviews are about your own rib cartilage. Donated cartilage avoids a chest incision but has its own trade-offs to ask about.

Is “rib revision” the same thing?

The search term “rib revision rhinoplasty” can mean two different things. For the nose, it usually means using rib cartilage in a revision rhinoplasty, covered above. Some web pages instead describe surgery on the chest wall itself, for example to correct problems at an earlier rib cartilage operation or donor site; that is a separate topic from nose surgery. If you have a problem at a chest donor site after a nose operation, tell the surgeon who operated on you.

What should you ask your surgeon about graft material?

• Where will the cartilage for my nose come from, and why?
• Is rib cartilage part of the plan? If so, what would you use if my septum turns out to be enough?
• If you take my own rib cartilage, where is the incision, how big is the scar and how will the chest feel afterward?
• Is donated cartilage an option, and what are its pros and cons?
• What is your own experience with warping and with revision after rib grafts?
• What is the price difference, if any, when rib cartilage is used?

In common practice in Turkey, rib cartilage in a primary rhinoplasty costs extra, and the length of stay stays the same (editorial note, October 2026).

For help comparing surgeons, see how to choose a rhinoplasty surgeon, and for questions about anesthesia see general anesthesia for nose surgery.

Sources

All pages were opened and checked on 10 October 2026.

• American Society of Plastic Surgeons, Rhinoplasty procedure: septal cartilage most often; ear occasionally; rib rarely.
• Bagunaid MA and colleagues, Harvesting costal cartilage for secondary rhinoplasty, Cureus, 2024.
• Novak M, Cason R, Rohrich RJ, Role of rib graft for tip shaping in primary rhinoplasty, Plastic and Reconstructive Surgery, 2024.
• Wee JH and colleagues, Complications associated with autologous rib cartilage use in rhinoplasty: a meta-analysis, JAMA Facial Plastic Surgery, 2015.
• Varadharajan K and colleagues, Complications associated with the use of autologous costal cartilage in rhinoplasty, Aesthetic Surgery Journal, 2015.
• British Association of Aesthetic Plastic Surgeons, Rhinoplasty.