Three Cartilage Sources Compared
연골 이식 (yeongol isik — cartilage graft) in rhinoplasty draws from three donor sites, each with distinct properties, harvest logistics, and appropriate use cases. The table below summarises the key variables surgeons weigh when selecting a source.
| Source | Harvest location | External scar | Volume available | Strength / rigidity | Best use cases | Warping risk |
|---|---|---|---|---|---|---|
| Septal cartilage | Inside the nose (nasal septum) | None | Low–moderate | High — firm and straight | Tip grafts, columellar strut, spreader grafts, minor dorsal work | Low |
| Ear (conchal) cartilage | Bowl of the outer ear (concha) | 1.5–2 cm behind ear | Moderate | Low–medium — soft, naturally curved | Shield grafts, spreader grafts, alar rim grafts, small defect filling | Low |
| Rib cartilage | Ribcage (typically 6th–8th rib) | 3–5 cm inframammary crease | High | Very high — strong, dense | Revision cases, major dorsal augmentation, columellar reconstruction, depleted septum | Moderate |
Septal Cartilage: The First Choice
The nasal septum — the internal wall dividing the two nostrils — contains a roughly rectangular plate of cartilage that sits at the centre of the nose. Because it is accessed through the same open rhinoplasty incision already required for the procedure, harvesting septal cartilage adds no additional external scar and no separate surgical site.
Septal cartilage is straight, relatively flat, and firm — properties that make it the most technically predictable cartilage for grafting. It carves cleanly into columellar struts (vertical supports placed inside the nose to project the tip), spreader grafts (thin strips placed alongside the septum to widen the internal nasal valve — the airway passage just inside the nostril — and prevent collapse), and tip grafts of various shapes.
The principal limitation is volume. The harvestable area of the septum is constrained: the surgeon must leave a stable L-shaped strut — the vertical and horizontal margins of the septum — intact to preserve nasal structural support. In most primary (first-time) rhinoplasties, the available septal cartilage is sufficient for tip work and moderate structural reinforcement. In patients who have had a prior rhinoplasty, the septum is frequently depleted or scarred, making septal cartilage unavailable or insufficient, and forcing the surgeon to source from the ear or rib.
Board-certified surgeons registered with the Korean Society of Plastic and Reconstructive Surgeons (KSPRS; 대한성형외과학회, Daehan Seonghyeong Oegwa Haghoe) — the official Korean certification board for plastic surgeons — complete a minimum six years of medical school and a four-year plastic surgery residency before earning the right to perform these procedures.¹
Ear Cartilage: When Septal Supply Is Insufficient
The concha — the bowl-shaped hollow at the centre of the outer ear — yields a disc of cartilage roughly 3–4 cm in diameter. The harvest incision is placed behind the ear, in the natural crease between the ear and the scalp, leaving a scar of approximately 1.5–2 cm that is not visible from the front and typically fades well within 12 months.
The key property of ear cartilage is its natural curvature and relative softness. This makes it well suited to grafts that benefit from gentle contour — alar rim grafts (thin strips placed along the rim of the nostril to prevent retraction or collapse), shield grafts (a shaped piece positioned at the tip to define tip projection and shape), and lateral crural grafts. The same softness is a limitation: ear cartilage lacks the rigidity to serve as a load-bearing columellar strut in cases that require significant structural projection, and it cannot provide the dense, straight material needed for major dorsal augmentation.
Ear cartilage is commonly used when septal cartilage is inadequate in volume but the overall structural demand of the case does not yet require the larger harvest of rib. It is also frequently combined with septal cartilage in a single operation — the surgeon uses each source for the grafts it performs best. One ear typically provides sufficient cartilage; both ears can be harvested if needed, with the structural integrity of the ear maintained in both cases.
Rib Cartilage: Revision Cases and Major Reconstruction
Rib cartilage — harvested from the lower ribcage, typically the 6th, 7th, or 8th rib — provides more raw material than septal and ear sources combined. A single rib segment yields a dense, strong block of cartilage that can be carved into multiple grafts: a full-length dorsal onlay, a robust columellar strut, spreader grafts, and tip grafts, all from the same harvest.
This volume and structural strength makes rib cartilage the necessary choice in several clinical situations. Revision rhinoplasty — surgery performed on a nose that has already been operated on — frequently presents with depleted or scarred septal cartilage and insufficient ear supply for the structural demands of correcting prior deformity. Collapsed middle vaults, severely retracted columellas, and noses with prior silicone implant complications all require the kind of structural reconstruction that only rib cartilage can provide.
The harvest leaves a 3–5 cm scar in the inframammary crease (the fold beneath the breast or chest), hidden under clothing. The incision is kept small through endoscopic or minimally open techniques where the anatomy allows.
The most significant technical challenge of rib cartilage is warping: once carved and removed from the ribcage, the graft may curve or twist as internal tensions within the cartilage redistribute. This can lead to visible asymmetry or deviation of the nasal tip or bridge in the months after surgery. Korean surgeons trained in rib cartilage rhinoplasty use several techniques to reduce warping — central core carving (taking material from the structural centre of the rib, where tension is more balanced), equal surface tension placement, internal fixation sutures, and opposing batten orientation for paired grafts.
As of 2024, approximately 2,100 board-certified plastic surgeons are registered with KSPRS in Korea.² Rib cartilage rhinoplasty is a subspecialty skill within that group — patient consultation should confirm the surgeon’s specific experience with autologous rib harvest and warping prevention.
How Korean Surgeons Choose Between Sources
The decision follows a hierarchy of need: use the simplest source that provides sufficient material for the structural demands of the specific case.
For a primary rhinoplasty requiring tip refinement and minor structural support, septal cartilage alone is typically sufficient. The surgeon plans the case around the available septal harvest and reserves ear cartilage as a secondary option if intraoperative volume proves insufficient.
When septal cartilage is available but the case requires moderate additional volume — for example, alar rim grafting combined with tip work — the surgeon may combine septal and ear cartilage from the same operative session.
Rib cartilage is selected when: (a) the patient has a prior rhinoplasty with depleted septal supply; (b) the structural demands of the case — major columellar reconstruction, extensive dorsal augmentation without implant, collapse correction — exceed what ear cartilage can support; or (c) the patient has previously had a silicone implant removed with significant soft tissue compromise, requiring robust structural rebuilding.
KSPRS board certification¹ — verifiable through the KSPRS public registry — is the baseline credential to confirm before any rhinoplasty consultation. For revision or rib cartilage cases specifically, ask the surgeon directly how many rib cartilage rhinoplasties they perform annually, what warping prevention method they use, and whether they plan a hybrid approach (rib structure at the tip, silicone dorsal implant) or full autologous reconstruction. These questions have specific, answerable responses — a surgeon experienced in this area will answer them without hesitation.
Is rib cartilage rhinoplasty better than silicone implant?
Neither is universally better — they solve different problems. Silicone implant (typically I-shaped for the dorsum) is simpler to place, involves no donor site, and is reversible. Rib cartilage carries no extrusion risk, is permanent living tissue, and provides structural strength for tip work that silicone cannot. Rib is strongly preferred for revision cases, major structural reconstruction, patients with thin skin, or those with prior implant complications. For primary dorsal augmentation with adequate tip cartilage, the hybrid approach is increasingly standard in Korean practice.
Will I have a scar from cartilage graft harvesting?
Septal cartilage: no external scar — harvested through the rhinoplasty incision inside the nose. Ear cartilage: a 1.5–2 cm scar behind the ear, typically invisible. Rib cartilage: a 3–5 cm scar in the inframammary crease (below the breast/chest fold), which fades to a pale line over 12 months and is hidden under clothing. Most patients find the rib donor site scar acceptable given the functional advantages of the graft.
What is warping in rib cartilage rhinoplasty and how is it prevented?
Rib cartilage can warp — curve or twist — over time as the carved graft adjusts to new mechanical forces outside its original anatomical position, potentially causing the tip or bridge to deviate or develop asymmetry in the months after surgery. Prevention methods include carving from the central, most stable section of the rib; placing the graft with equal tension on both surfaces; securing with internal fixation sutures; and using opposing batten orientation for paired grafts. Ask your surgeon specifically which technique they use.