Dr. Nassif: A very tedious process is rib carving. The rib is sometimes very difficult to carve because it’s a little bit stronger, and you have to be very careful when you carve it because it can fracture. We have to make grafts out of the rib cartilage.
One thing we want to do when we’re carving rib is to soak it in normal saline and in this fluid it softens it up and gives it this curve of where the cartilage is going to go. On the inner cortex on the rib has less chance of warping, so we want to make sure we leave that intact. What we’re trying to do is leave a nice layer.
In Liz’s case I needed a straight piece of cartilage for what we call a spreader graft. So I want to get this nice and thin so I can use this as a spreader graft or a lateral crural strut graft. Then we needed other pieces of cartilage called rim grafts which are on the nostrils and that I do want it curved. So we have to actually carve it so that it starts to curve. So it’s a very difficult thing to do and it takes a good amount of time to do it.
So we’re gently carving; in this you have to be very careful when you carve because if you go a little bit too deep you’ll splinter the rib. In Liz’s case we are able to do all that. We also were able to take small pieces where we can use them for camouflage of the whole right nasal bone region. So here’s the carved rib, it might be a little thick right now but depending on what we’ll need we’ll bring it down a little smaller by bruising it.
So it just went absolutely perfect. Today it’s her three month post-op. She looks great, she’s still healing and she’s still swollen. She can breathe a lot better than before surgery; she’s exactly where she should be and right now the way it looks I think this hopefully will be her last surgery. I’m extremely happy with where she’s at right now, I love her nose, and it’s only going to get better.
