Autologous costal cartilage rhinoplasty is based on viable transplantation and is conducted by processing a segment of the costal cartilage harvested from the patient before it is immediately emplaced inside the nose. Compared with the common open (Korean-style) rhinoplasty, autologous costal cartilage rhinoplasty has the similar surgical method which necessitates to make an open columellar incision, but there is no need to use any artificial prosthesis or nasal septal/auricular cartilage graft because it has a sole requirement of autologous costal cartilage. The site for harvesting the costal cartilage varies along with the gender and rib feature of the patient and is generally at the 6th or 7th rib because it is mostly straight and long enough for the augmentation of the nasal bridge. The incision for the collection of the rib is approximately 3.5 cm and will only leave a thin scar at the anterior chest wall under good wound care. After the costal cartilage is harvested, necessary management will be performed on the rib to prevent curving, including segmentation, straightening, molding, and scoring, and it is then implanted into the nasal bridge, nasal tip, and nasal columella in light of the surgical design. The rib is sculpted into an L-shaped stent to reconstruct an ideal nose shape, and cartilages at multiple sites are then stitched and fixated. Technically as long as the ribs collected are of sufficient length and mass, there will no problem in reconstructing the whole nose.
Dr. Chuang considers that this surgery poses a great detriment to body tissues because the costal cartilage will never regrow after being removed; therefore, it seems to be overdone in applying the costal cartilage for primary or simple esthetic rhinoplasty. Moreover, costal cartilage transplantation has concerns of warping, and approximately 10–15% of patients show different degrees of nasal bridge deviation within 1 year postoperatively, 5–8% of whom will need to undergo revision surgery. Although there are some surgeries currently conducted to break chondrocyte memory and prevent autologous warping, this problem still cannot be completely eradicated. Patients should understand all the advantages and disadvantages of the surgery before making a decision. From the perspective of Dr. Chuang, this surgery is suitable for revision rhinoplasty or traumatic nose reconstruction or for patients with nasal deformity or contracture due to prosthesis infection or removal, and it is also used as the ultimate method to correct a difficult rhinoplasty like excess short nose or saddle nose. In this way, an appropriate plan can be derived that balances surgical risks and patient expectations.