Complications Associated With the Use of Autologous Costal Cartilage in Rhinoplasty: A Systematic Review

Varadharajan K, Sethukumar P, Anwar M, Patel K.

What this paper says

Pooling 21 studies, rib cartilage rhinoplasty carried a 5.2 percent rate of graft warping, 2.9 percent scar problems at the chest and 0.1 percent pneumothorax.

Overview

Rib cartilage is a common graft source when a nose needs substantial rebuilding, but the risks at both the chest and the nose had not been formally pooled. The authors searched EMBASE, PubMed, MEDLINE and the Cochrane Database, plus references of relevant papers, from January 1980 to July 2014, then screened studies against set criteria and combined the data.

Sections of note

21 eligible studies were included. The total number of patients is not stated in the abstract.
Chest complications pooled: pneumothorax 0.1 percent, pleural tear 0.6 percent, infection 0.6 percent, seroma 0.6 percent, scar-related problems 2.9 percent, severe pain 0.2 percent.
Nose complications pooled: warping 5.2 percent, infection 2.5 percent, displacement or extrusion 0.6 percent, graft fracture 0.2 percent, resorption 0.9 percent.
Warping was the most common problem at either site.
The authors conclude the operation remains safe but that minor complications at the nose are not negligible.
Level of evidence 4, therapeutic.

What it means for a patient

Serious chest problems such as a punctured lung lining were rare, occurring in well under one percent of pooled cases.
The most likely issue is the cartilage graft bending over time, affecting roughly one patient in twenty.
Infection at the nose occurred in about one patient in forty, higher than the chest infection rate.
A systematic review inherits the weaknesses of the studies it pools, and these were case series without control groups, with follow-up length not stated in the abstract.

Why this paper matters

Rib cartilage is the fallback when septal and ear cartilage are exhausted, which makes it central to revision rhinoplasty. Pooled figures give a basis for consent that a single surgeon's experience cannot. What is unanswered is how long warping takes to appear and how often it leads to further surgery.

Terms

Autologous costal cartilage: rib cartilage taken from the patient's own chest.
Systematic review: a structured search and pooling of all studies meeting set criteria.
Warping: gradual bending of a cartilage graft after it is placed.
Pneumothorax: air leaking into the chest cavity, causing partial lung collapse.
Pleural tear: a tear in the lining around the lung, which can lead to pneumothorax.
Seroma: a collection of clear fluid in a surgical wound.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“Autologous costal cartilage grafts are common in rhinoplasty. To date, no formal systematic review of complications associated with autologous costal cartilage grafting in rhinoplasty exists. Objectives: The authors review current literature to examine the rates of donor and recipient site complications associated…”

Excerpt; the full abstract is on PubMed.