Analysis of the Cause of Cartilage Warping in the Rhinoplasty of Costal Cartilage and Application of Embed-In Graft in Revisional Surgery

Xu Y, Zhang X, You J, Wang H, Zheng R, Wu L, Tian L, Guo J, Fan F.

PubMed 36656674 Publisher (DOI)

What this paper says

In 32 patients needing revision after rib cartilage rhinoplasty, the authors found that a nasal hump left incompletely removed at the first surgery contributed to the cartilage bending, and they corrected it with a new embed-in graft.

Overview

Rib cartilage is a common source of graft material in rhinoplasty, but it tends to warp, meaning it bends or curls after being carved and placed. This study asked whether causes outside the cartilage itself drive warping, and how to fix already warped cartilage during a second operation. The authors retrospectively reviewed their warping cases from the previous five years.

Sections of note

Design: retrospective case review of cartilage warping cases over five years, single practice.
Participants: 29 women and 3 men, ages 18 to 60, average age 32.5 years.
All cases were corrected with an embed-in graft designed by the authors.
Reported external cause: a dorsal hump not fully removed during the original surgery.
The authors state warping was particularly affected in the sagittal plane, the front to back profile direction.
Reported result: all patients were satisfied with the outcome. No follow up length, measurements or comparison group are given in the abstract.

What it means for a patient

Warping after rib cartilage rhinoplasty may not be caused only by the cartilage. Leftover hump underneath it can push the graft out of shape.
The embed-in graft is presented as a rescue for severely warped cartilage, not as a routine part of a first rhinoplasty.
Limits are substantial: 32 patients, one group, no control arm, no stated follow up period, and satisfaction reported without a named scoring tool.

Why this paper matters

Warping is one of the recurring problems with rib cartilage, and most published work addresses how to carve or balance the graft rather than what lies beneath it. Pointing to residual hump shifts attention to the surgical bed. Whether complete hump removal actually lowers warping rates would need a comparative study.

Terms

Costal cartilage: cartilage from the ribs, harvested for use as a graft.
Warping: bending or curling of a cartilage graft after it is carved and placed.
Revision surgery: a second operation to correct the result of an earlier one.
Dorsal hump: the bump of bone and cartilage on the bridge of the nose.
Sagittal plane: the front to back plane seen in a side profile view.

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

From the abstract

“It is undeniable that costal cartilage is an excellent source of grafts, however it has some potential disadvantages, including a tendency to warp. There are very few studies that have examined how to resolve preexisting cartilage warping during secondary revisional surgery. Objectives: The aim of this study was to…”

Excerpt; the full abstract is on PubMed.