Grafting Techniques in Primary and Revision Rhinoplasty

Wong BJF, Friedman O, Hamilton GS 3rd.

What this paper says

A case-based review of structural cartilage grafting, arguing that open structure rhinoplasty relies on grafts to resist the shape changes caused over time by gravity and aging.

Overview

As rhinoplasty moved toward open structural technique, added cartilage became central rather than occasional. This article covers how graft types have evolved for both first-time and revision surgery, and presents the material through worked cases rather than as a list of techniques.

Sections of note

The adoption of open structure techniques is identified as the reason grafting became central.
Structural grafts are described as resisting change over time from gravity and the aging process.
Surgical procedures are described as having become more technically complex.
Graft types used in both primary and secondary rhinoplasty have undergone significant evolution.
The article takes a case-based approach focused on structural grafting.
No specific graft types are named in the abstract, and no patient numbers, outcome rates, or follow-up are reported.

What it means for a patient

Cartilage grafts in modern rhinoplasty are largely there to hold the shape over years, not only to change it at the time of surgery.
Revision surgery uses different grafts than first-time surgery, in part because the original cartilage supply may be gone.
This is a review article without data, so it does not compare graft types or report how long results hold.

Why this paper matters

The shift from reduction to structural rhinoplasty is the main change in the field over recent decades, and grafting is its practical expression. A case-based format matches how the technique is taught. The abstract carries no evidence on which grafts perform best or for how long.

Terms

Structural graft: A cartilage piece placed to hold shape and resist collapse over time.
Open structure technique: Surgery through a columellar incision that rebuilds the framework with grafts and sutures.
Primary rhinoplasty: A patient's first nose operation.
Secondary or revision rhinoplasty: An operation on a nose already operated on.
Case approach: Teaching through worked patient examples rather than abstract description.

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

From the abstract

“With the adoption of open structure techniques, rhinoplasty has become more reliant on the use of structural grafts to resist change that occurs over time owing to both gravity and the aging process. As surgical procedures have become more technically complex, the type of grafts use for both primary and secondary…”

Excerpt; the full abstract is on PubMed.