The rib is a generous source of donor cartilage. Thus, costal cartilage harvest is a frequently performed adjunctive procedure in facial plastic and reconstructive surgery. Pneumothorax is an uncommon complication of rib graft harvest but is potentially highly morbid. Although chest radiography is the current diagnostic study of choice to rule out air in the chest, there is growing evidence that ultrasonography is less expensive and more sensitive. Furthermore, the portability of the ultrasonographic unit allows for immediate evaluation and more rapid diagnosis. The use of ultrasonography also precludes exposing the patient to ionizing radiation. We present a case in which ultrasonography was used to rapidly confirm the absence of pneumothorax after costal cartilage harvest and review the literature associated with use of ultrasonography for detection of this uncommon but serious complication.