Many people assume rhinoplasty is simply about removing a dorsal hump or narrowing the nasal bridge. When surgery focuses only on surface changes, long-term problems such as nasal tip droop, asymmetry, or breathing difficulties can develop.

The reality is that the nose is not a static structure. It is a living framework exposed to constant forces from gravity, facial movement, and the natural ageing process. This is why cartilage grafting has shifted from being an optional technique to a foundational principle in modern rhinoplasty.

Cartilage grafts function as the internal scaffolding of the nose. Rather than relying solely on tissue removal, surgeons use the patient’s own cartilage, commonly from the septum, ear, or rib, to reinforce weakened areas, support nasal function, and maintain structural stability over the long term.

Why Structural Stability Matters in Rhinoplasty

The nose is not a static structure. It is exposed to continuous mechanical forces from respiration, facial movement, gravity, and tissue ageing. When cartilage support is excessively removed or inadequately reconstructed, these forces can lead to delayed complications such as nasal tip droop, asymmetry, and airway compromise. This understanding explains why cartilage grafting in rhinoplasty has become foundational rather than optional.

Stable outcomes depend on maintaining a strong internal nasal framework. Cartilage grafts act as architectural supports that resist collapse, preserve projection, and maintain alignment as tissues heal and mature.

Why Are Cartilage Grafts Used in Rhinoplasty?

Cartilage grafts are used because they provide predictable, long-term structural support while remaining biologically compatible with the patient’s own tissue. Unlike synthetic implants, autologous cartilage integrates naturally, adapts to mechanical stress, and carries a low risk of rejection or extrusion.

Cartilage grafting in rhinoplasty addresses these risks by reinforcing weak anatomical zones and restoring internal support. This shift from reduction-based techniques toward structural reconstruction represents a fundamental change in rhinoplasty philosophy (Sheen, 1984).

What Cartilage Is Used in Nose Surgery?

The choice of graft material depends on anatomical requirements, surgical goals, and whether the procedure is primary or revision surgery.

• Septal cartilage is the preferred source in most primary rhinoplasty cases. It is straight, strong, and centrally located, making it ideal for dorsal support, tip projection, and internal valve reinforcement.
• Auricular (ear) cartilage is curved and more flexible. It is commonly used for alar rim support and contour refinement, particularly when septal cartilage is insufficient or unavailable.
• Costal (rib) cartilage is reserved for complex nasal cartilage reconstruction, especially in revision rhinoplasty. It provides substantial volume and strength but requires careful carving to control warping.

Each source serves a specific biomechanical purpose rather than being interchangeable.

Functional Rhinoplasty Techniques and Cartilage Support

Functional rhinoplasty techniques focus on maintaining or restoring nasal airflow, particularly at the nasal valve region—the narrowest and most resistance-prone segment of the airway.

Spreader grafts, first described by Sheen, are placed between the septum and upper lateral cartilages to widen and stabilise the internal nasal valve while reconstructing the middle vault after dorsal reduction (Sheen, 1984). Subsequent studies have confirmed their role in both therapeutic and preventive settings (Teymoortash et al., 2012).

Alar batten grafts reinforce the lateral nasal wall, addressing dynamic collapse of the external or internal nasal valve. Clinical series by Toriumi and colleagues demonstrated sustained improvement in nasal airflow when these grafts were used in appropriately selected patients (Toriumi et al., 1997).

Do Cartilage Grafts Improve Rhinoplasty Results?

Clinical evidence and long-term outcome studies indicate that rhinoplasty cartilage grafts improve predictability, symmetry, and functional preservation. Grafting reduces the incidence of postoperative deformities such as the inverted-V deformity, internal valve collapse, and tip instability (Samaha et al., 2015).

From a functional standpoint, grafts are closely associated with improved airflow outcomes when placed appropriately. Structural reinforcement allows surgeons to address aesthetic goals without compromising breathing mechanics.

Cartilage Grafts in Revision Rhinoplasty

Revision rhinoplasty frequently addresses structural failure rather than cosmetic dissatisfaction alone. Common issues include loss of tip support, nasal valve collapse, and dorsal irregularities caused by excessive cartilage removal during prior surgery.

In these cases, rhinoplasty cartilage grafts are essential. Revision procedures often involve rebuilding the nasal framework from the inside out, using cartilage grafting to restore strength, alignment, and airway stability.

Ageing, Healing, and Long-Term Stability

Facial ageing affects skin elasticity, ligament strength, and soft-tissue support. Cartilage grafts counteract these processes by maintaining skeletal projection and contour as overlying tissues change. Long-term follow-up studies consistently show that graft-supported rhinoplasty ages more predictably than reduction-based techniques.

The Evolution of Rhinoplasty Philosophy

The modern approach to rhinoplasty prioritises preservation, reinforcement, and reconstruction. Cartilage grafting in rhinoplasty reflects a broader shift toward respecting nasal anatomy rather than overpowering it. Surgical success is now measured by how well results endure, not how dramatic they appear immediately after surgery.

Conclusion

Cartilage graft rhinoplasty is fundamental to stable, functional, and long-lasting outcomes. By reinforcing the nasal framework, cartilage grafts preserve both appearance and breathing function while allowing results to age predictably. As rhinoplasty continues to evolve, structural grafting remains the cornerstone of responsible and effective nasal surgery.

Why Choose Dr Laith Barnouti for Rhinoplasty and Facial Surgery

Dr Laith Barnouti is a Sydney-based FRACS (Plast)–qualified specialist plastic surgeon with over 20 years of experience in rhinoplasty and facial surgery. His approach is grounded in detailed facial anatomical analysis and precise surgical planning, with careful consideration of both nasal function and facial balance.

Each procedure is planned on an individual basis, using evidence-based techniques and meticulous execution to support patient safety, structural stability, and long-term outcomes. This approach prioritises predictable healing, preserved airflow, and natural facial harmony rather than short-term cosmetic change.

References:

Sheen, J.H. (1984). Spreader graft: A method of reconstructing the roof of the middle nasal vault following rhinoplasty. Plastic and Reconstructive Surgery, 73(2), 230–239.

Toriumi, D.M., et al. (1997). Use of alar batten grafts for correction of nasal valve collapse. Archives of Otolaryngology–Head & Neck Surgery, 123(8), 802–808.

Teymoortash, A., et al. (2012). The value of spreader grafts in rhinoplasty: A critical review. European Archives of Oto-Rhino-Laryngology, 269(5), 1411–1416.

Samaha, M., et al. (2015). Spreader graft placement in endonasal rhinoplasty. Facial Plastic Surgery, 31(4), 393–399.