Complications Associated with Autologous Costal Cartilage Used in Rhinoplasty: An Updated Meta-Analysis

Chen H, Wang X, Deng Y.

PubMed 36071242 Publisher (DOI)Free full text (PMC)

What this paper says

Pooling 20 studies covering 1,648 patients, rhinoplasty using the patient's own rib cartilage carried an overall complication rate of 15.13 percent, with warping the most common at 3.05 percent.

Overview

The study set out to estimate complications from using the patient's own rib cartilage as graft material in rhinoplasty, drawing on newly published literature. Studies published between July 1990 and April 2020 were searched systematically and pooled using a random effects model.

Sections of note

Meta analysis of 20 studies covering 1,648 patients; the journal assigns level of evidence III.
Pooled warping rate was 3.05 percent, 95 percent confidence interval 1.36 to 5.19 percent.
Resorption was 1.2 percent and infection 1.45 percent.
Contour irregularity was 1.53 percent and the revision rate 2.25 percent.
At the donor site, thickened chest scar occurred in 2.08 percent and collapsed lung in 0 percent.
Pooled complications at the nose, excluding revision surgery, were 9.06 percent.
Donor site complications were 1.47 percent and the overall rate 15.13 percent.
The authors state donor site complications increased the overall complication rate by 22 percent, and that revision rates have risen in recent years.

What it means for a patient

About one patient in seven had some complication when the numbers from both the nose and the chest are combined.
Warping was the most frequent single problem, consistent with the known behaviour of rib cartilage.
No collapsed lung was recorded across 1,648 patients, though thickened chest scarring occurred in about one in 48.
The included studies were largely case series rather than randomized trials, so pooled rates carry that limitation.

Why this paper matters

Rib cartilage is the fallback when septal and ear cartilage are insufficient, and its complication profile determines whether that trade off is acceptable. This meta analysis quantifies the rates at both the nose and the chest. It offers no comparison against donor or synthetic alternatives.

Terms

Autologous costal cartilage: rib cartilage taken from the patient's own body.
Warping: gradual bending of a cartilage graft after placement.
Resorption: gradual absorption and loss of graft material by the body.
Contour irregularity: an uneven surface visible or palpable through the skin.
Donor site morbidity: problems at the place the graft was taken from.
Random effects model: a statistical method allowing for real differences between studies.

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

Abstract

Objective: To estimate the complications using autologous costal cartilage as grafts in rhinoplasty objectively and systematically with newly published literature.

Methods: The literature was searched systematically; included studies were published between July of 1990 and April of 2020. Meta-analysis was performed using a random-effects model.

Results: Twenty studies involving 1648 patients were included for meta-analysis. The pooled rates of complications were 3.05% of warping (95% CI 1.36-5.19%), 1.2% of resorption (95% CI 0.26-2.56%), 1.45% of infection (95% CI 0.34-3.06%), and 1.53% of contour irregularity (95% CI 0.53-2.88%). The revision rate was 2.25% (95% CI 0.96-3.9%). Regarding of donor-site morbidities, the rate of hypertrophic chest scar was 2.08% (95% CI 0.31-4.83%), and the rate of pneumothorax was 0% (95% CI 0-0.46%). The pooled rates of complications were 9.06% (95% CI 6.13-12.43%) at the recipient site when complications at the recipient site did not include revision surgery, 1.47% (95% CI 0.17-3.56%) at the donor site, and 15.13% (95%CI 11.03-19.69%) overall. The recipient-site adverse event rate was 12.44% (95% CI 8.98-16.33%).

Conclusions: Warping was found the most common complication after rhinoplasty with autologous costal cartilage. Revision after rhinoplasty using autologous costal cartilage was increased in these years. Donor-site complications increased the complication rate after rhinoplasty using autologous rib cartilage by 22%.

Level Of Evidence Iii: 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).