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Rib Grafts in Rhinoplasty: A Systematic Review and Meta-analysis of Autologous, Fresh-frozen, and Irradiated
Shaishav Datta1,2, Elie P Ramly3,4, Victoria Tucci2
1From the Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Plastic and Reconstructive Surgery. Global Open
|June 30, 2026
Summary
Autologous and cadaveric costal cartilage (CC) grafts show similar low risks for infection and warping in rhinoplasty. Revision rates varied, with fresh-frozen cadaveric CC appearing most favorable, though more research is needed.
Area of Science:
- Plastic Surgery
- Biomaterials Science
- Surgical Outcomes Research
Background:
- Costal cartilage (CC) is a common graft in rhinoplasty, sourced from autologous (ACC) or cadaveric (FFCC, IHCC) options.
- Comparative safety profiles regarding infection, warping, and revision surgery for these CC graft types remain unclear.
Purpose of the Study:
- To systematically review and compare the safety profiles of autologous costal cartilage (ACC), fresh-frozen cadaveric costal cartilage (FFCC), and irradiated homologous costal cartilage (IHCC) in rhinoplasty.
- To evaluate primary outcomes including infection, warping, and revision surgery rates across different CC graft types.
Main Methods:
- A systematic review adhering to PRISMA guidelines was conducted, searching multiple databases up to April 2025.
- Studies evaluating ACC, FFCC, or IHCC in rhinoplasty were included, with data pooled using random-effects meta-analysis.
- Heterogeneity was assessed using I-squared statistics.
Main Results:
- Twenty-five studies involving 2322 patients were analyzed (ACC=775, FFCC=1076, IHCC=471).
- Infection (1%-2%) and warping (1%-3%) rates were low across all graft types, with minimal heterogeneity for infection.
- Revision rates varied (1% for FFCC to 7% for ACC/IHCC), exhibiting high heterogeneity and asymmetry, though non-inferiority for infection and warping was supported.
Conclusions:
- Infection and warping are infrequent complications for all costal cartilage graft types, suggesting comparable safety.
- Fresh-frozen cadaveric costal cartilage (FFCC) showed the most favorable revision outcomes, but heterogeneity and study design limited definitive conclusions.
- Higher-quality prospective studies are needed to standardize outcome reporting and inform optimal graft selection in rhinoplasty.