Cartilage Graft Material in Revision Surgery

In short. Where graft material comes from, what each source costs the patient, and why the choice is anatomical rather than cosmetic in a revision.

Key points

• The choice is not about which material is better in the abstract.
• It is about how much support is needed, how thin the skin over it is, how much septum remains, and how the graft will behave in that particular nose.
• Two patients with the same complaint can be offered different material for reasons that are entirely structural.

Every structural change to a nose needs material, and in a revision the choice of material is made by anatomy rather than by preference. What is available depends on what the first operation used, and each source carries a different cost to the patient in healing and in certainty.

The septum, when it is still there

Septal cartilage is the natural first choice. It is the same type of tissue as the framework it supports, it sits inside the operative field, and it is flat and stable enough to be shaped predictably. Where the first operation left useful quantities of it, a revision is a more forgiving operation than one that must find material somewhere else.

The ear

Ear cartilage is the usual alternative. It is taken through an incision behind the ear, which leaves a scar there, and it is thinner and curved compared with septal cartilage, so it has to be shaped before it can support anything. The ear itself is not usually altered. The trade is a second surgical site for material that is reliably available.

The rib, and the commitment it carries

Rib cartilage provides the largest amount of firm support and is used where a significant amount of structure is needed. It is taken through an incision on the chest wall, which is a larger procedure with its own recovery, and the graft can change shape over time. It is reserved for noses that genuinely need that much support.

Materials other than the patient’s own cartilage

Other options exist, including processed tissue and manufactured implants, and each behaves differently, is tolerated differently and ages differently. They are described by material class rather than by product name, and whether any is appropriate is decided by the anatomy and by the history of the previous operations.

What the patient is deciding

Where a graft is taken from is a decision about a second surgical site, a longer recovery and a different set of uncertainties. That belongs in the conversation before an operation, together with what the graft is expected to achieve, because a patient who understands the source of the material understands most of what the operation involves.

What the assessment establishes before any material is chosen is set out in The Work-Up Before Nasal Revision. Why a second operation has less to work with is covered in Why a Second Nose Operation Is Harder.

Related reading

• Breathing Problems After Nose Surgery
• Red Flags After Nose Surgery: What to Do Now
• Skin Problems Over a Graft: Thinning, Show and Colour

Frequently asked questions

Why is septal cartilage preferred if it is available?

It is the same kind of tissue as the framework it is supporting, it is already inside the surgical field, and it is flat and stable in a way that makes it predictable to shape. Where it remains in useful quantity, a revision is a more forgiving operation than one that has to look elsewhere.

What does taking cartilage from the ear involve?

It leaves a scar behind the ear and it produces a smaller, curved piece of cartilage that has to be shaped before it can support anything. The ear itself is not usually changed in shape. It is a reasonable source where the septum has been used, and it means a second surgical site with its own healing.

Is donated or artificial material used?

Material other than the patient’s own cartilage exists, and each option has a different profile of how it behaves and how it is tolerated over time. Which, if any, is appropriate is an anatomical question answered at assessment, and it is discussed in terms of the material class rather than a brand.

Risks & Limitations

• A revision cannot promise a better result than the operation it is correcting. It can improve a named problem, and it can introduce a different one while doing so.
• There is usually less cartilage available the second time, more scar tissue between the layers, and a tighter skin envelope that limits how much structure can be added before it shows.
• A nose continues to change for roughly a year, so a result judged early is usually wrong and a revision planned early is planned from a shape that will not exist.
• Two findings inside the nose — a collection of blood in the septum and a hole in it — can damage the support of the nose if they are not assessed promptly.

When to Seek Care

• Breathing through the nose that keeps worsening, or a nose that is swelling fast — seek emergency care now.
• Heavy bleeding that does not stop, or bleeding that restarts after it had settled — seek emergency care now.
• Skin over the tip or bridge turning white, dusky, blistered or black — seek emergency care now.
• A fever with spreading redness, heat or pus around the nose or septum — seek care the same day.
• A hole, a whistling sound, or a crusting sore inside the nose that does not heal — seek care the same day.

References & Further Reading

• American Society of Plastic Surgeons (ASPS) — procedure and safety guidance
• National Institute for Health and Care Excellence (NICE, UK) — relevant guidance
• Cochrane Library — systematic reviews
• Chinese Medical Association Plastic Surgery Branch — clinical guidance

Medically reviewed by Tongchun Mao, MD (毛彤春), Deputy Director & Head of Aesthetic Surgery. Last reviewed: 19 September 2026.

This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.