Facial Plast Surg 2023; 39(06): 625-629
DOI: 10.1055/a-2116-4566
Original Article

Considerations for Optimal Grafting in Rhinoplasty

1   Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
Robin W. Lindsay
2   Department of Otolaryngology-Facial Plastic and Reconstructive Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
Natalie Justicz
3   Department of Otorhinolaryngology-Facial Plastic and Reconstructive Surgery, University of Maryland, Baltimore, Maryland
› Author Affiliations


A wide variety of grafting materials and techniques can be used to create functional and aesthetic changes in rhinoplasty. Choosing the optimal grafting approach is critical to achieving an optimal patient outcome. We present a review of autografts, allografts, and alloplasts used in primary and revision rhinoplasty and discuss factors that impact graft choice. Autologous grafts serve as the pillar for grafting material in rhinoplasty given their reliable long-term outcomes, low rates of infection, resorption, and extrusion, and ability to provide structural scaffolding as well as contour. Cadaveric allografts can be utilized as a source of grafting material in certain clinical scenarios including revision rhinoplasty and have been shown to be equally safe and effective as autologous grafts while avoiding donor-site morbidity. Alloplasts can prove useful in rhinoplasty in cases of iatrogenic nasal deformities or revision cases. Careful consideration of clinical scenario, patient factors, and outcome goals is necessary to choose the appropriate grafting approach to address functional and cosmetic outcomes.

Publication History

Accepted Manuscript online:
22 June 2023

Article published online:
24 July 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

  • References

  • 1 Maas CS, Monhian N, Shah SB. Implants in rhinoplasty. Facial Plast Surg 1997; 13 (04) 279-290
  • 2 Chen C, Patel R, Chi J. Comprehensive algorithm for nasal ala reconstruction: utility of the auricular composite graft. Surg J (NY) 2018; 4 (02) e55-e61
  • 3 Ho TT, Cochran T, Sykes KJ, Humphrey CD, Kriet JD. Costal and auricular cartilage grafts for nasal reconstruction: an anatomic analysis. Ann Otol Rhinol Laryngol 2017; 126 (10) 706-711
  • 4 Singh DJ, Bartlett SP. Aesthetic management of the ear as a donor site. Plast Reconstr Surg 2007; 120 (04) 899-908
  • 5 Varman R, Clark M. Butterfly graft technique for addressing the internal nasal valve. Facial Plast Surg 2022; 38 (04) 347-352
  • 6 Brandon BM, Austin GK, Fleischman G. et al. Comparison of airflow between spreader grafts and butterfly grafts using computational flow dynamics in a cadaveric model. JAMA Facial Plast Surg 2018; 20 (03) 215-221
  • 7 Clark JM, Cook TA. The ‘butterfly’ graft in functional secondary rhinoplasty. Laryngoscope 2002; 112 (11) 1917-1925
  • 8 Moshaver A, Gantous A. The use of autogenous costal cartilage graft in septorhinoplasty. Otolaryngol Head Neck Surg 2007; 137 (06) 862-867
  • 9 Farkas JP, Lee MR, Lakianhi C, Rohrich RJ. Effects of carving plane, level of harvest, and oppositional suturing techniques on costal cartilage warping. Plast Reconstr Surg 2013; 132 (02) 319-325
  • 10 Moon BJ, Lee HJ, Jang YJ. Outcomes following rhinoplasty using autologous costal cartilage. Arch Facial Plast Surg 2012; 14 (03) 175-180
  • 11 Justicz N, Fuller JC, Levesque P, Lindsay RW. Comparison of NOSE scores following functional septorhinoplasty using autologous versus cadaveric rib. Facial Plast Surg 2019; 35 (01) 103-108
  • 12 Varadharajan K, Sethukumar P, Anwar M, Patel K. Complications associated with the use of autologous costal cartilage in rhinoplasty: a systematic review. Aesthet Surg J 2015; 35 (06) 644-652
  • 13 Özücer B, Dinç ME, Paltura C. et al. Association of autologous costal cartilage harvesting technique with donor-site pain in patients undergoing rhinoplasty. JAMA Facial Plast Surg 2018; 20 (02) 136-140
  • 14 Lee HJ, Bukhari S, Jang YJ. Dorsal augmentation using crushed autologous costal cartilage in rhinoplasty. Laryngoscope 2021; 131 (07) E2181-E2187
  • 15 Emerick KS, Hadlock TA, Cheney ML. Nasofacial reconstruction with calvarial bone grafts in compromised defects. Laryngoscope 2008; 118 (09) 1534-1538
  • 16 Zins JE, Whitaker LA. Membranous vs endochondral bone autografts: implications for craniofacial reconstruction. Surg Forum 1979; 30: 521-523
  • 17 Ezzat WH, Compton RA, Basa KC, Levi J. Reconstructive techniques for the saddle nose deformity in granulomatosis with polyangiitis: a systematic review. JAMA Otolaryngol Head Neck Surg 2017; 143 (05) 507-512
  • 18 Shipchandler TZ, Chung BJ, Alam DS. Saddle nose deformity reconstruction with a split calvarial bone L-shaped strut. Arch Facial Plast Surg 2008; 10 (05) 305-311
  • 19 Demirtas Y, Yavuzer R, Findikcioglu K, Atabay K, Jackson IT. Fixation of the split calvarial graft in nasal reconstruction. J Craniofac Surg 2006; 17 (01) 131-138
  • 20 Jenny HE, Siegel N, Yang R, Redett RJ. Safety of irradiated homologous costal cartilage graft in cleft rhinoplasty. Plast Reconstr Surg 2021; 147 (01) 76e-81e
  • 21 Kadakia N, Nguyen C, Motakef S, Hill M, Gupta S. Is irradiated homologous costal cartilage reliable? A meta-analysis of complication rates in rhinoplasty. Plast Surg (Oakv) 2022; 30 (03) 212-221
  • 22 Luan CW, Chen MY, Yan AZ. et al. Complications associated with irradiated homologous costal cartilage use in rhinoplasty: a systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2022; 75 (07) 2359-2367
  • 23 Mohan R, Shanmuga Krishnan RR, Rohrich RJ. Role of fresh frozen cartilage in revision rhinoplasty. Plast Reconstr Surg 2019; 144 (03) 614-622
  • 24 Rohrich RJ, Abraham J, Alleyne B, Bellamy J, Mohan R. Fresh frozen rib cartilage grafts in revision rhinoplasty: a 9-year experience. Plast Reconstr Surg 2022; 150 (01) 58-62
  • 25 Vila PM, Jeanpierre LM, Rizzi CJ, Yaeger LH, Chi JJ. Comparison of autologous vs homologous costal cartilage grafts in dorsal augmentation rhinoplasty: a systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg 2020; 146 (04) 347-354
  • 26 Starr NC, Creel L, Harryman C, Gupta N. Cost utility analysis of costal cartilage autografts and human cadaveric allografts in rhinoplasty. Ann Otol Rhinol Laryngol 2022; 131 (10) 1123-1129
  • 27 Fuller JC, Levesque PA, Lindsay RW. Polydioxanone plates are safe and effective for L-strut support in functional septorhinoplasty. Laryngoscope 2017; 127 (12) 2725-2730
  • 28 Boenisch M, Mink A. Clinical and histological results of septoplasty with a resorbable implant. Arch Otolaryngol Head Neck Surg 2000; 126 (11) 1373-1377
  • 29 Tweedie DJ, Lo S, Rowe-Jones JM. Reconstruction of the nasal septum using perforated and unperforated polydioxanone foil. Arch Facial Plast Surg 2010; 12 (02) 106-113
  • 30 Caughlin BP, Been MJ, Rashan AR, Toriumi DM. The effect of polydioxanone absorbable plates in septorhinoplasty for stabilizing caudal septal extension grafts. JAMA Facial Plast Surg 2015; 17 (02) 120-125
  • 31 Choi JY. Complications of alloplast rhinoplasty and their management: a comprehensive review. Facial Plast Surg 2020; 36 (05) 517-527
  • 32 Jung DH, Kim BR, Choi JY, Rho YS, Park HJ, Han WW. Gross and pathologic analysis of long-term silicone implants inserted into the human body for augmentation rhinoplasty: 221 revision cases. Plast Reconstr Surg 2007; 120 (07) 1997-2003
  • 33 Fuller JC, Levesque PA, Lindsay RW. Analysis of patient-perceived nasal appearance evaluations following functional septorhinoplasty with spreader graft placement. JAMA Facial Plast Surg 2019; 21 (04) 305-311
  • 34 Lindsay RW. Disease-specific quality of life outcomes in functional rhinoplasty. Laryngoscope 2012; 122 (07) 1480-1488
  • 35 Hismi A, Burks CA, Locascio JJ, Lindsay RW. Comparative effectiveness of cartilage grafts in functional rhinoplasty for nasal sidewall collapse. Facial Plast Surg Aesthet Med 2022; 24 (03) 240-246