Fresh Frozen Cadaveric Cartilage: A Novel Option for Asian Rhinoplasty

Rhinoplasty is a common plastic surgery procedure, but ethnic variation in nasal anatomy and aesthetic ideals makes it challenging among Asian patients. Asian rhinoplasty typically involves augmentation rather than reduction, leading many surgeons to use alloplastic implants, which can have complications such as extrusion, skin thinning, displacement, and translucency. Autologous cartilage is considered ideal, but Asian patients often have less septal cartilage compared with White patients, making autologous rib cartilage a frequent choice despite disadvantages (longer operative time, risk of pneumothorax, hypertrophic scars, pain, added cost, and warping). Fresh frozen cadaveric costal allograft (CCA) from the Musculoskeletal Transplant Foundation processed without irradiation is proposed as a novel option, and this study reports its use in five Asian patients.

- Study design: Case series of five Eastern Asian ethnicity patients undergoing augmentation rhinoplasty using fresh frozen costal cartilage allografts (CCAs). IRB approval and informed consent obtained. - Graft source and processing: CCAs harvested from donors’ 7th–9th ribs; stored at −40°C to −80°C. Temperature maintained with dry ice during shipment. Prior to implantation, grafts were thawed in normal saline. Allografts were processed without irradiation under high sterility standards. - Surgical application: Grafts used variably as spreader grafts, columellar struts, tip elevation grafts, septal extension grafts, and dorsal onlay grafts, tailored to patient needs. - Outcomes and measurements: • Standardized pre- and postoperative photographs obtained. • Anthropometric measurements on 2D photographs: nasofrontal angle, nasofacial angle, nasolabial angle, and Goode ratio. Stability assessed by change between two postoperative timepoints (Δ = |measurement at visit 1 − visit 2|), comparing 2–4 months vs 8–20 months after surgery. • Patient-reported outcomes: FACE-Q Satisfaction with Nose (10 items) and Satisfaction with Nostrils (5 items) administered preoperatively and at 1 year postoperatively; higher scores indicate greater satisfaction. • Complications recorded during follow-up. - Follow-up: Mean 14.2 ± 3.35 months (range 12–20 months).

- Five Asian patients underwent rhinoplasty with CCA; mean follow-up 14.2 ± 3.35 months. - Safety/complications: No major adverse events. No infection, resorption, or warping documented at 1 year. One patient had a minor scar noted in the clinical table; others had none. - Objective stability: Across subjects with complete photographic follow-up, the inter-visit change (Δ) in anthropometric measurements between 2–4 months and 8–20 months post-op had a mean of 0.93°, range 0.01°–3.63°, indicating stable results with minimal change. - Patient-reported outcomes: FACE-Q Satisfaction with Nose improved from 35.2 ± 10.06 pre-op to 60 ± 15.48 at 1 year (P = 0.0002). FACE-Q Satisfaction with Nostrils improved from 42.6 ± 20.31 to 59.8 ± 38.21 (P = 0.12).

The case series suggests fresh frozen CCA is a reliable augmentation material for Asian rhinoplasty, addressing limitations of both alloplastic implants (risk of extrusion, thinning, displacement, translucency) and autologous cartilage (limited septal supply; rib harvest morbidities including hypertrophic scarring, longer operative time, pain, cost). Historically, concerns about cadaveric cartilage centered on higher resorption and infection due to irradiation. The non-irradiated, sterilely processed CCAs used here showed no resorption, warping, or infection at 1 year, and objective measures remained stable between early (2–4 months) and later (8–20 months) postoperative periods. Patient satisfaction improved, particularly for overall nasal satisfaction. The material may also reduce costs when procedures can be performed in office settings, avoiding operating room and general anesthesia fees. Given variability in ethnic aesthetics and individualized surgical goals, the study focused on postoperative stability over time rather than comparisons to universal ideal nasal proportions.

Fresh frozen costal cartilage allograft is an excellent option for Asian augmentation rhinoplasty, offering abundant material without donor site morbidity, shorter operative time, and lower surgical costs compared with autologous rib cartilage. In this case series, CCAs were safe, demonstrated stable structural outcomes without resorption or warping at 1 year, and yielded improved patient satisfaction. Larger studies with longer follow-up are warranted to further validate safety, efficacy, and durability.

- Small sample size (n = 5) and single-surgeon case series limit generalizability. - Short-to-intermediate follow-up (12–20 months); long-term resorption/warping risk beyond this period remains unknown. - One subject lacked complete photographic follow-up at later timepoints, though reported satisfaction on FACE-Q. - No control group (e.g., autologous rib or alloplastic implants) for direct comparison of outcomes and complications. - Heterogeneity in patient anatomy and personalized goals; no pre- vs postoperative anthropometric comparisons to standardized ideals. - Potential bias due to funding support from the Musculoskeletal Transplant Foundation.