The Application of a New Framework Construction Technique in Autologous Costal Cartilage Rhinoplasty

Gu Q, Li J, Fu Z, Wang J, Feng X, Sun Y, Yan S, Jin P, Wu S.

PubMed 39703382 Publisher (DOI)Free full text (PMC)

What this paper says

In 65 patients whose nasal framework was rebuilt from sixth rib cartilage using a new assembly method, all measured proportions improved with no short term complications and no tip deflection or rotation.

Overview

The authors tested a new way of assembling a rib cartilage framework in rhinoplasty. The sixth costal cartilage was carved into three components: a columellar support strut, a tip graft with an integrated scaffold, and septal extension grafts. The strut and the extension grafts were sutured together to form the framework. Patients treated at a provincial hospital between January 2020 and February 2022 were enrolled.

Sections of note

Design: case series, 65 patients aged 19 to 43, average age 26.0 years.
Follow up: 9 to 23 months. Photographic measurements were taken before surgery and at 9 months.
Measures: nasal length, tip projection, nasofrontal angle, columellar to lobular angle and nasolabial angle, analyzed in Adobe Photoshop with paired t tests.
All measurements differed significantly after surgery, p less than 0.05.
Satisfaction was assessed with a visual analog scale and the Rhinoplasty Outcome Evaluation, both showing significant improvement, p less than 0.05.
No short term complications occurred.
The authors state no obvious deflection or rotation of the tip occurred.

What it means for a patient

Framework deflection, meaning the rebuilt structure leaning off centre, is the recurring problem with rib frameworks, and none was reported here.
Interlocking the strut with the septal extension grafts by suture creates a single rigid unit rather than separate pieces.
Using rib means a chest incision and a second surgical site, which the abstract does not discuss.
Limits: 65 patients, single centre, no comparison group, follow up under two years, and measurements taken from two dimensional photographs.

Why this paper matters

Rib frameworks supply the strength that thin native cartilage cannot, but they can shift, bend or rotate once the soft tissue settles over them. How the pieces are assembled determines that. Whether this construction holds better than conventional assembly over several years is untested.

Terms

Costal cartilage: cartilage from the ribs, harvested for use as a graft.
Columellar strut: a cartilage post placed between the nostrils to support the tip.
Septal extension graft: cartilage fixed to the septum that carries the tip in a set position.
Nasofrontal angle: the angle between the forehead and the bridge of the nose.
Columellar-lobular angle: the angle between the strip under the nostrils and the underside of the tip.
Deflection: a structure leaning away from the intended midline position.

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

Abstract

Background: In this study, the clinical efficacy of a new framework construction technique for costal cartilage rhinoplasty was investigated.

Methods: From January 2020 to February 2022, patients who underwent rhinoplasty in the department of plastic and reconstructive surgery of Zhejiang Provincial People's Hospital were enrolled. The sixth costal cartilage was made into the nasal columellar support graft (strut), the nasal tip graft integrated scaffold, and the septal extension grafts. The strut and septal extension grafts were sutured to construct the framework. Adobe Photoshop 6.0 was used to measure a series of aesthetic indices preoperatively and at 9 months postoperatively, including the nasal length, tip projection, nasofrontal angle, columellar/lobular angle, and nasolabial angle. The visual analog scale score and rhinoplasty outcome evaluation score were used to assess patient satisfaction. A paired t test was used for data analysis, and a P value of less than 0.05 was considered to indicate statistical significance.

Results: A total of 65 patients aged 19-43 years (average age 26.0 y) were enrolled. No short-term complications occurred. All patients were followed up for 9-23 months. There were statistically significant differences in all measurements (P < 0.05), which suggested that the aesthetic defects of the nose were corrected and that no obvious deflection or rotation of the nasal tip occurred. The visual analog scale score and rhinoplasty outcome evaluation score indicated a significant improvement in patient satisfaction (P < 0.05).

Conclusions: This new framework construction technique for costal cartilage rhinoplasty can reduce the risk of framework deflection and nasal tip rotation and provide a satisfactory nasal columellar shape.

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