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Page 2 of 7 Olcott et al. Plast Aesthet Res 2019;6:3 I http://dx.doi.org/10.20517/2347-9264.2018.79

Conclusion: Two thirds of the US facial plastic surgeons performed autologous costal cartilage harvest in a hospital
setting. Routine chest imaging or overnight observation post-operatively was not warranted as the percentage of
pneumothorax remained low and pain control was adequate.

Keywords: Rib graft, autologous costal cartilage, rhinoplasty, current practice, pneumothorax

INTRODUCTION
Rhinoplasty remains one of the most demanding operations of the cosmetic and reconstructive surgeon
due to the complex three-dimensional anatomy of the nose, which serves both form and function. The nose
sits in the center of a face, even the slightest asymmetry or imperfection is apparent causing significant
patient distress and dissatisfaction. This may explain how rhinoplasty was the fifth most popular cosmetic
procedure in 2015, with close to 218,000 performed, according to the data from the American Society of
[1]
Plastic Surgeons . In 2017, the American Academy of Facial Plastic & Reconstructive Surgery (AAFPRS)
published a membership study which showed rhinoplasty was the most commonly performed surgical
[2]
procedure among facial plastic surgeons with each surgeon performing 60 of those annually on average .
The revision rhinoplasty rate had been reported in the literature between 5% and 15.5% even in the hands of
[3,4]
experienced surgeons . Despite our best efforts, the primary surgical outcome may not be acceptable to the
patient, physician or both. Many patients seek revision rhinoplasty to correct minor deformities. However,
some of these cases are more involved requiring repair of cosmetic and/or functional defects.

The challenges presented by revision rhinoplasty are not only with regard to scarring and distorted
anatomy, but the amount of material available for reconstruction. Residual septal cartilage and auricular
conchal cartilage are first considered but often depleted especially in a multiple revision case. Auricular
conchal cartilage, being a type of elastic cartilage, is also not as structurally strong as hyaline cartilages
found in septum and ribs. As a result, autologous costal cartilage harvest becomes a common practice to
provide cartilage material in revision rhinoplasties. Costal cartilage is sometimes used in augmentation
rhinoplasty for congenitally small noses as well as in ethnic rhinoplasty for African Americans and
Asians. Other options for graft source include irradiated cadaveric rib, allografts [e.g., silicone, expanded
polytetrafluoroethylene (e-PTFE, Gore-tex, WL Gore and Associates, Flagstaff, AZ) and porous polyethylene
(Medpor, Porex Surgical, Newnan, GA)].

METHODS
An online 10-question survey [Table 1] was distributed to 2,639 members of the American Academy of
Facial Plastic & Reconstructive Surgery. Survey respondents were asked about their years of experience,
number of autologous costal cartilage harvest performed annually, their techniques, rate of pneumothorax,
safety practices and post-operative management. Data were exported and analyzed in Excel software
(Microsoft corporation).

RESULTS
Of the 2,639 AAFPRS members, 2,379 members received the survey and 137 (5.76%) members responded.
The majority (46 of 137, 33.6%) of the respondents were facial plastic surgeons with > 20 years experience
[Figure 1]. One hundred and nine (79.6%, n = 137) of the respondents performed autologous rib harvest with
49.6% of them performing the procedure at a hospital facility. Among them, 21.5% exclusively performed
their rhinoplasty with autologous rib harvest at an ambulatory surgical center (ASC) not physically attached
to a hospital while 6.67% of them at the in-office accredited operating room. Four respondents (2.92%)
chose between a hospital facility and ASC on a case-by-case basis [Figure 2]. The number of autologous
rib harvests performed annually range between 1 and > 50. Many respondents (36.6%) performed between