Say you are reading a quote on a Tuesday evening and one line says “cartilage graft: septum, ear or rib, decided during surgery.” It sounds like a detail until you ask where the second wound would be, and whether it changes the price.
Key takeaways
- The American Society of Plastic Surgeons says graft cartilage most commonly comes from the septum, occasionally from the ear and rarely from the rib.
- Each source adds something different to the plan: nothing extra for the septum, an ear wound for ear cartilage, a chest incision for your own rib, and no second wound for donor rib.
- A 2020 meta-analysis found no difference in warping, resorption, infection or revision between your own rib cartilage and donor rib cartilage in bridge grafts.
- Taking cartilage away to reshape the tip is a different step from adding a graft, and a quote should say which one it covers.
Surgeons most often take graft cartilage from the septum, the wall inside the nose. The American Society of Plastic Surgeons (ASPS) says ear cartilage is used occasionally and rib cartilage rarely. Donated (cadaver) rib cartilage is another option. The source decides where any extra scar sits, how much material is available and what you might pay.
What is a cartilage graft and why would a nose need one?
A cartilage graft is a piece of cartilage added to the nose to give it structure. The ASPS says rhinoplasty sometimes requires the addition of cartilage grafts. A 2020 meta-analysis puts the purpose plainly: augmentation rhinoplasty adds cartilage to give the structure of the nose more support. Typical jobs are shaping and holding up the tip, for example with a septal extension graft (a strut attached to the septum that helps set tip projection and rotation), or building up the bridge.
The term for cartilage taken from your own body is autologous. Cartilage from a human donor, processed and stored by a tissue bank, is called an allograft, homologous or “cadaver” cartilage. Clinics use these words loosely, so ask which one a quote means.
Where can the cartilage come from?
| Source | How often (ASPS) | Where it is taken | Donor-site issues in the literature |
|---|---|---|---|
| Septum | Most commonly | Inside the nose | Not reported as a separate wound |
| Ear (conchal) cartilage | Occasionally | The bowl of the ear | Hematoma, scarring, wound-healing problems |
| Your own rib | Rarely | Chest, usually the seventh rib, under general anesthesia | Chest scar; pneumothorax, pleural tear, pain reported at low rates |
| Donor rib | Not in the ASPS list | Tissue bank, nothing taken from you | No donor wound; see the donor cartilage guide for graft risks |
The ear row comes from a 2018 case report, which lists those donor-site problems and notes that conchal cartilage has become increasingly popular in secondary nasal reconstruction. The rib row combines a 2024 review of rib harvesting with the two reviews in the next section. The British Association of Aesthetic Plastic Surgeons adds the general point: if cartilage, bone or skin is taken from another part of the body, it leaves a scar that may be noticeable.
What do studies report about taking rib cartilage?
A meta-analysis and a systematic review of your own rib cartilage in rhinoplasty give the numbers. They count different things, so read them side by side rather than adding them up.
- A 2015 meta-analysis in JAMA Facial Plastic Surgery pooled 491 patients with a mean follow-up of 33.3 months. Warping was 3.08%, hypertrophic (raised) chest scarring 5.45%, pneumothorax (a collapsed lung from air entering the chest) 0%, and revision surgery 14.07%. The authors called overall complications low but said warping and chest scarring deserved attention.
- A 2015 review in Aesthetic Surgery Journal of 21 studies reported donor-site pneumothorax in 0.1%, pleural tear 0.6%, scar-related problems 2.9% and severe donor-site pain 0.2%. On the nose side, warping was 5.2% and infection 2.5%.
Warping means the graft bends as it heals. Resorption means the body absorbs part of it. Both can change the shape months later, which is why follow-up length matters when you compare studies.
Is one source better than the others?
The studies below compare only a few pairs of sources, and none of them names one source as best for every nose.
On your own rib versus donor rib for bridge grafts, a 2020 meta-analysis of 28 studies found no difference in warping (5%), resorption (2%), contour irregularity (1%), infection (2%) or revision (5%). Details on donor products and revision data are in our guide to cadaver rib cartilage.
On ear versus rib for the tip, a 2025 study of 27 patients followed them for about 453 days on average. Both gave enough support in the short term, but the ear cartilage lost more tip height and volume. The authors concluded that rib cartilage held up better. The group was small and the two groups received different graft designs, so it points in one direction without settling the question. Our guide to ear cartilage in rhinoplasty covers the other side, including a 2026 series of 1,710 primary operations from one team that reported a 0.35% complication rate.
When does a surgeon go beyond the septum?
When the septum is not enough. A 2024 review describes septal cartilage as usually the first option, with rib considered when it is insufficient. Revisions come up often in these papers, because an earlier operation may already have used the septal cartilage. See revision rhinoplasty for how that plays out.
Primary operations can need it too. In a single surgeon’s series, 30 of 638 primary rhinoplasties (4.7%) required a fresh frozen donor rib graft, and every one of them used a septal extension graft. The author reported that 7 of the 30 had a history of nasal trauma, and concluded that a septal extension graft gives precise tip shaping in noses with thick skin, a weak cartilage framework or a history of trauma. Our guide to rib cartilage in primary rhinoplasty goes through it.
Is cartilage removal the same as a graft?
No. Removal reshapes what is already there, and a graft adds material. BAAPS describes tip surgery in which the cartilage under the tip needs to be partly removed or reshaped. That can happen with no graft at all. If you searched “cartilage removal nose” after reading a quote, check whether the line means trimming, a graft or both, because only a graft brings a donor site into the conversation. For tip work in general, see tipplasty.
What should the quote and the consent form say?
Bring these to the consultation, or send them in writing before you book:
- Which cartilage source is planned, and why that one for my nose?
- If the septum turns out to be enough, what is used and does the price change?
- Who decides during the operation, and will I be told afterward what was used?
- If rib is possible, where is the incision and what should the chest feel like afterward?
- If donor cartilage is offered, which product is it, where does it come from and how long has this surgeon followed such grafts?
- Will I get an operation note naming the graft source? (In common practice in Turkey, records are handed over at discharge; editorial note, October 2026.)
On price, in common practice in Turkey, rib cartilage in a primary rhinoplasty costs extra and the length of stay stays the same (editorial note, October 2026). Put the answer into your trip budget next to the other line items, and see how to choose a surgeon for the wider checklist. The printable clinic checklist has room for these answers.
Sources
Pages checked 22 October 2026.
- American Society of Plastic Surgeons, Rhinoplasty procedure.
- British Association of Aesthetic Plastic Surgeons, Rhinoplasty.
- Vila PM and colleagues, Autologous vs homologous costal cartilage grafts in dorsal augmentation rhinoplasty, JAMA Otolaryngology, 2020.
- Wee JH and colleagues, Complications associated with autologous rib cartilage use in rhinoplasty, JAMA Facial Plastic Surgery, 2015.
- Varadharajan K and colleagues, Complications associated with the use of autologous costal cartilage in rhinoplasty, Aesthetic Surgery Journal, 2015.
- Bagunaid MA and colleagues, Harvesting costal cartilage for secondary rhinoplasty, Cureus, 2024.
- Novak M, Cason R, Rohrich RJ, Role of rib graft for tip shaping in primary rhinoplasty, Plastic and Reconstructive Surgery, 2024.
- Mundra and colleagues, Iatrogenic conchal defect secondary to auricular cartilage graft, Journal of Craniofacial Surgery, 2018.
- Kim and Kim, Absorbable plate-assisted columellar strut graft using auricular cartilage: 1710 cases, Journal of Clinical Medicine, 2026.
- Li and colleagues, Long-term resorption rates of conchal and rib cartilage grafts in nasal tip plasty, Aesthetic Plastic Surgery, 2025.
