Journal archive · Rib, ear and septal grafts · Outcomes, satisfaction and psychology · Complications and management · 2026
Outcomes and complications of autologous versus alloplastic grafts in augmentation rhinoplasty: A systematic review of studies from 2000 to 2024
Khatlah ANB, AlKaabba AF, Almari AR, Al-Tayar NR, Alsarar AA, Alhajress DI, Alshehri MF, Alzahrani MH, Assiri OF, Alzahrani NS.
In the archive as a landmark paper: the core sweep runs 2011–2026, and this one is here because the history of rhinoplasty rests on it · cited on alloplastic implants.
Abstract
Background: Augmentation rhinoplasty requires careful selection of graft material to achieve aesthetic and functional success. Autologous cartilage and alloplastic implants remain the most widely used options, each with distinct advantages and risks.
Methods: A systematic review was conducted of studies published between 2000 and 2024. Eligible designs included randomized controlled trials, cohort and case-control studies, and large case series (≥10 patients). Three databases (PubMed, Embase, and Scopus) were searched in accordance with PRISMA 2020 guidelines, and full search strategies are provided in the appendix for reproducibility. No PROSPERO registration was undertaken; however, a predefined protocol was followed to ensure transparency and methodological rigor. Risk of bias was assessed using RoB 2 for randomized trials and ROBINS‑I for observational studies.
Results: Twenty‑eight studies met inclusion criteria, representing diverse geographic regions and graft practices. Autologous grafts, especially costal cartilage, were associated with lower infection and extrusion rates, but carried risks of warping and occasional resorption. Alloplastic implants, most commonly silicone and Gore‑Tex, provided operative efficiency but demonstrated higher infection and extrusion rates, particularly in long‑term follow‑up. Meta‑analysis of 10 studies (n = 7019) revealed a significantly lower infection risk with autologous grafts (OR = 0.19; 95% CI: 0.09-0.42; p < 0.001).
Conclusions: Autologous cartilage remains the preferred option for complex, high-risk, or revision rhinoplasty, while alloplastic implants may be appropriate in carefully selected primary cases. Future studies should incorporate standardized patient-reported outcome measures and longer follow-up to improve comparability and clinical relevance.Level of Evidence: Level III.
Abstract as indexed by PubMed; the article is open access (PubMed Central).
Citation
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What the rhinoplasty literature says on this paper's topics, cited line by line to PubMed.
Rib, ear and septal grafts
Modern rhinoplasty builds rather than removes, so the operation runs on cartilage: the septum first, then the ear, then the rib, and when none of those will do, a piece of donated rib from a tissue bank.
Outcomes, satisfaction and psychology
Rhinoplasty is measured with ten different questionnaires, none of which covers both the way the nose looks and the way it breathes, and the best-developed one has no airway questions at all.
Complications and management
Serious complications after rhinoplasty are rare: infection runs under 1% in the two largest single-surgeon series, pooled rib harvests record no pneumothorax, and the bleeding series record no thromboembolism.
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