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2026.01.17
Will rib cartilage eventually bend? | Why warping occurs and how to prevent it
As a board-certified plastic surgeon, I have handled numerous cases involving trauma, reconstruction, and congenital conditions, cultivating precise techniques and deep anatomical understanding. Driven by the desire to deliver the transformative power of beauty—where visible change uplifts the spirit—I pursued a career in cosmetic surgery. My areas of expertise include comprehensive eye treatments, injectable therapies, and anti-sagging procedures. Guided by a commitment to sincerely address each patient's aspirations, I provide meticulously crafted treatments focused on achieving beauty.
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Rib cartilage is one of the strongest, thickest, and most supportive grafting materials used in rhinoplasty.
It is less easily deformed than the auricular cartilage or nasal septum cartilage and retains its structure more easily, so it plays an important role in surgeries that require clear support, such as nasal septum extension and nasal dorsoplasty.
On the other hand, it is often understood that "rib cartilage will not change shape over time.
In practice, however, even rib cartilage can warp and twist during the postoperative course, which is called warping.
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What is warping?
Warping is a phenomenon in which the transplanted cartilage deviates from its original shape over time, warping and curving.
In rhinoplasty, the nasal bridge appears slightly crooked instead of straight, the nasal bridge tilts to one side, and the tip of the nose is uneven.
Most changes occur within a few months after surgery, but in some cases they become gradually more noticeable six months or more later, so even if there are no problems in the early postoperative period, there is no guarantee of relief.
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Why is it bent even in the rib cartilage?
Rib cartilage is a hard material, but as a living tissue, it retains internal forces.
The costal cartilage isOriginally arched shapeand even if it is processed straight, there remains a repulsive force inside that tries to return it to its original shape.
This force can surface over time, which can cause warping and twisting.
In addition, if there is a difference in the amount or thickness of grinding on the left and right sides during processing, the balance of internal stresses will be disrupted.
Even if it looks straight, if there is an unbalanced application of force, it will easily deform in a certain direction.
In addition, the relationship with surrounding tissues, such as postoperative adhesions and compressions, also affect the results.
Even if there is no problem with the cartilage itself, it can change shape as a result of continuous external force in one direction.
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If warping occurs
If it is mild, it may be barely noticeable to others.
However, if distortion of the nasal bridge or tilt of the nasal column is visible, it must be corrected because it affects the overall impression of the face.
When considering a correction, it is important to sort out in which direction the force was applied, rather than simply looking at the deformed area.
If we do not figure out where it was fixed and where there was no escape, the same deformity may occur again.
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Concepts for preventing warping
Over the use of rib cartilage,Design for warping possibilities.It is necessary.
First, the nature of the cartilage varies depending on the site from which it is harvested.
Since the stronger the initial curvature, the more resilience is likely to be produced, select an area where the shape is relatively stable.
During the processing stage, the thickness and the amount of removal are adjusted so that they are not biased in one direction.
Left-right differences and imbalances in cross-sectional shape lead to deformation in time.
Another effective design is to combine multiple cartilages to distribute the repulsive force, instead of building the structure with only one cartilage.
Fixation is also made to prevent rotation and displacement by supporting the patient at multiple points, rather than strongly holding the patient at a single point.
These are decisions that are based on assumptions about the shape of the future, from a few months to a few years from now.
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Importance of postoperative management
Even with proper design and fixation, the risk of deformity remains if postoperative management is inadequate.
Fixation methods to avoid compression, rest periods, and medical examinations according to progress are necessary.
Postoperative follow-up is more important, especially in revision surgery, because there is more internal scarring and the forces on the cartilage are more complex.
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■ Summary
Rib cartilage is a strong graft material, but may warp and twist over time.
The risk depends on the nature of the cartilage, the balance of processing and fixation, and the forces applied postoperatively.
To prevent warping, it is important to design on the premise of selecting the site of collection, processing and fixation, and postoperative management.
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【Profile】
Masataka Fujihashi, MD, Plastic Surgeon
Leveraging expertise as a board-certified plastic surgeon, I offer comprehensive facial cosmetic procedures including eyelid and nose surgery, facial liposuction, thread lifts, and hyaluronic acid injections. From incisional surgeries and revision procedures requiring delicate design to minimally invasive injections and lifts with minimal downtime, I strive to provide treatments tailored to each patient's ideal outcome.
We are dedicated to achieving natural results and minimizing downtime, pursuing medical care that leaves you feeling confident in your choice through sincere consultations.
Designing natural beauty with trust.
We cherish that sentiment and apply it to our daily practice.
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【Career】
March 2015: Graduated from the School of Medicine, Showa University
April 2015 Showa University Yokohama Northern Hospital Initial Clinical Training
April 2017 Showa University Hospital Department of Plastic Surgery
October 2017 Maebashi Red Cross Hospital Plastic Surgery / Cosmetic Surgery
April 2019 Nishio Municipal Hospital Plastic Surgery Department
April 2020 Showa University Fujigaoka Hospital Plastic Surgery Department
November 2020 Ota Nishinouchi Hospital Plastic Surgery / Cosmetic Surgery
July 2022 Tokyo Rosai Hospital Plastic Surgery / Cosmetic Surgery Department Head
July 2022: R.O.clinic (Part-time), Kusano Taro Clinic (Part-time)
April 2024 Deputy Director, Ginza TA Clinic
November 2025 BIANCA CLINIC
【Professional Affiliations and Qualifications】
Japanese Society of Plastic and Reconstructive Surgery Board-Certified Plastic Surgeon
Member of the Japanese Society of Aesthetic Plastic Surgery (JSAPS)
Member of the Japanese Society of Aesthetic Surgery (JSAS)
