Role of Fresh Frozen Cartilage in Revision Rhinoplasty

Mohan R, Shanmuga Krishnan RR, Rohrich RJ.

What this paper says

Among 50 revision rhinoplasty patients grafted with fresh frozen non-irradiated donor rib cartilage, there was one infection (2 percent) and no warping or extrusion over an average follow-up of 3.35 months.

Overview

Revision rhinoplasty usually needs cartilage, and the septum is typically already used. Rib from the patient carries chest incision complications and adds operating time; irradiated donor rib has higher rates of shrinkage and infection. This study reports early experience with a third option, donor rib frozen rather than irradiated.

Sections of note

Operative data of 50 patients who had secondary rhinoplasty by the senior author between 2014 and 2017.
Outcomes were rated from before and after photographs by four blinded plastic surgeons using the Independent Rhinoplasty Outcome Score.
Average follow-up 3.35 months, range 1 to 18 months.
One complication, an infection, 2 percent, which did not require revision surgery.
No warping and no extrusion occurred in the cohort.
The authors state further long-term studies with larger samples are needed to show fresh frozen cartilage is better than other sources.
Level of evidence IV, therapeutic. The abstract reports no outcome score values.

What it means for a patient

Donor cartilage avoids a chest incision and the recovery that comes with it.
Freezing rather than irradiating is intended to avoid the shrinkage associated with irradiated grafts.
The average follow-up of 3.35 months is too short to observe resorption or late warping, which develop over years.
Limits: 50 patients, one surgeon, no comparison group, and the authors themselves describe the evidence as insufficient to claim superiority.

Why this paper matters

The choice of graft material in revision rhinoplasty trades donor site morbidity against implant behavior, and no option is settled. Fresh frozen donor cartilage is a candidate that avoids both the harvest and irradiation. The short follow-up leaves the central question, long-term resorption, unanswered.

Terms

Fresh frozen cartilage: Donor cartilage preserved by freezing rather than by radiation.
Irradiated allograft: Donor tissue sterilized with radiation.
Autologous costal cartilage: Rib cartilage taken from the patient's own chest.
Warping: Bending of a solid cartilage graft after implantation.
Extrusion: A graft or implant working its way out through the skin or lining.

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

From the abstract

“Correction of secondary nasal deformities frequently requires cartilage to build the framework of the nose. Traditionally, autologous costal cartilage has been used because of the paucity of the septal cartilage. Because of associated donor-site complications and increased operating time, irradiated allografts have…”

Excerpt; the full abstract is on PubMed.