Absorbable Plate-Assisted Columellar Strut Graft Using Auricular Cartilage: A Large-Scale Clinical Study of 1710 Cases in Rhinoplasty

Abstract

Background: Columellar strut grafting is a widely adopted technique for nasal tip support in rhinoplasty; however, autologous cartilage grafts are associated with well-recognized limitations, including resorption, warping, and donor-site morbidity. Absorbable plates composed of poly-L-lactic acid (PLA) or poly-lactic-co-glycolic acid (PLGA), which have an established role in craniofacial fracture fixation, were investigated as a structural adjunct to auricular cartilage columellar strut grafts. The present study evaluates the safety and clinical outcomes of this technique in a large patient cohort. Methods: A retrospective review was conducted of 1710 consecutive patients who underwent primary rhinoplasty with absorbable plate-assisted columellar strut grafting between November 2012 and June 2022. A PLA plate (n = 792) or PLGA plate (n = 918) was used in combination with auricular conchal cartilage. Nasal tip projection was assessed using standardized clinical photographs and Ricketts' E-line analysis at a minimum follow-up of 1 month (range, 1 month to 6 years). Results: Satisfactory nasal tip projection was achieved and sustained throughout the follow-up period in the majority of patients. Transient mild overprojection, attributable to intentional overcorrection, resolved consistently by 6 months postoperatively. Among patients with recorded follow-up, the overall complication rate was 0.35% (6 of 1710 patients): 1 case of minor skin exposure and 1 case requiring revision for the aesthetic desire of further tip elevation (rather than structural projection loss) in the PLA group and 4 cases of mucosal penetration in the PLGA group, all of which occurred during the initial learning phase and resolved without sequelae. No delayed infections were recorded. Conclusions: Absorbable plate-assisted columellar strut grafting using auricular conchal cartilage is a safe, reproducible, and effective technique for achieving stable nasal tip projection. By providing temporary structural support during the critical early healing phase and subsequently undergoing biologic resorption, this approach mitigates the long-term risks associated with permanent implants while avoiding the morbidity of costal cartilage harvest. Despite the limitations of a retrospective design lacking a cartilage-only control group and objective three-dimensional volumetric assessments, it represents a viable and practical alternative for nasal tip support, particularly in East Asian patients with thick skin envelopes and weak cartilaginous frameworks.

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