The Use of Autologous and Cadaveric Grafts in Rhinoplasty: A Survey Study

Starr NC, Zachary Porterfield J, Harryman C, Gupta N.

PubMed 35043249 Publisher (DOI)Free full text (PMC)

What this paper says

Surveying 178 American facial plastic surgeons, 96.6 percent use the patient's own septal cartilage and 56.7 percent also use donor rib cartilage, with high case volume and patient health problems predicting donor use.

Overview

Both the patient's own tissue and donor tissue are used in rhinoplasty to add volume and support. The literature compares them on effectiveness, cost and complication rates without resolving which is better once availability, donor site injury and cost are weighed. Little has been published on what surgeons actually use. A 12 question survey was distributed to practicing members of the American Academy of Facial Plastic and Reconstructive Surgery.

Sections of note

Survey study; 178 respondents, an overall response rate of 17.5 percent; the journal assigns level of evidence V.
The most common graft was the patient's own septal cartilage, used by 96.6 percent.
The patient's own ear cartilage was used by 93.8 percent.
The patient's own rib was used by 75.8 percent.
Donor rib cartilage was used by 56.7 percent.
Patient health problems correlated positively with use of donor rib.
Performing more than 50 rhinoplasties per year also correlated positively with donor rib use.
Concerns about complications and about cost correlated negatively with donor rib use.

What it means for a patient

Most surgeons take cartilage from the patient's own septum or ear first, and turn to rib or donor tissue when more is needed.
Just over half use donor rib, which avoids a chest incision but adds cost and, for some surgeons, complication concerns.
Higher volume surgeons were more likely to use donor tissue, and surgeons treating patients with health problems likewise.
A 17.5 percent response rate means most members did not answer, so the figures may not represent the whole membership.

Why this paper matters

Graft source determines whether a patient gets a second surgical site, and the choice is made by the surgeon rather than by evidence of superiority. This survey documents what is actually used and what drives the decision. It reports no outcomes for any graft type.

Terms

Autologous graft: tissue taken from the patient's own body.
Cadaveric graft: tissue from a deceased donor, processed for surgical use.
Septal cartilage: the cartilage of the central partition inside the nose.
Auricular graft: cartilage taken from the ear.
Donor site morbidity: problems at the place the graft was taken from.
Comorbidity: an additional health condition a patient has alongside the reason for surgery.

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

Abstract

Background: Both autologous and cadaveric grafts are often used during rhinoplasty to create volume and provide support. Despite discussion in the literature comparing the efficacy, cost-effectiveness, and complication rates between grafting options, it remains unclear which is the superior choice when considering availability, donor site morbidity, and cost. There is a little description of the current use of these materials amongst facial plastic surgeons.

Methods: A 12 question survey was created, and IRB approval was obtained. The survey was distributed to practicing members of the AAFPRS via their membership listserv.

Results: 178 respondents completed the survey for an overall response rate of 17.5%. The most common rhinoplasty graft types used by respondents were autologous septal cartilage (96.6%), autologous auricular grafts (93.8%), autologous rib graft (ARG) (75.8%), and cadaveric rib graft (CRG) (56.7%). Patient comorbidities and performing more than 50 rhinoplasties per year were positively correlated with use of CRG grafts and concerns about complications and cost were negatively correlated.

Conclusions: While autologous septal and auricular cartilage remain the most common graft choices amongst surveyed facial plastic surgeons, a majority utilize cadaveric rib grafts in their practice. Patient comorbidities, surgery volume, concerns about graft complications, and cost were the chief factors associated with use of cadaveric grafts amongst survey respondents.

Level Of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).