Can auricular cartilage grafting change the nasal tip? Strengths and weaknesses of ear cartilage, and limits revealed by research

Auricular cartilage grafting is suitable for fine-tuning the shape of the nasal tip, but it is not ideal for making it significantly larger, taller, or providing long-term support[1][2]. Research on the nasal tip in Asian populations reports that ear cartilage tends to lose height more readily than rib cartilage over an average period of 453 days[3]. The suitability depends on how much change you want to achieve.

What kind of nose is ear cartilage suitable for?

In Asian populations, the cartilage of the nasal septum inside the nose (nasal septal cartilage) is often small, and ear cartilage is frequently used[4]. Textbooks note that it has sufficient length and strength for transfer[4].

Ear cartilage has a natural curve and flexibility, making it well-suited for refining the shape of the nose tip or raising the bridge of the nose.[1]On the other hand, because the quantity is limited, it is difficult to use for grafts that require substantial structural support.[1].

Does height decrease over time?

It can decrease. In a study comparing 27 patients who underwent nose-tip surgery using 3D photography, those who received ear cartilage grafts showed a greater reduction in nose-tip height over time compared to those who received rib cartilage grafts.[3]The follow-up period averaged 453 days.[3].

Textbooks also note that ear cartilage may weaken nasal support over time and may not provide adequate long-term shape and function.[2]If size or strength is insufficient, revision surgery may become necessary.[2].

However, this comparison involved a small number of patients (27), and the study was conducted by reviewing past medical records.[3]Keep in mind that results may vary.

How does it compare to rib cartilage or septal cartilage?

Rib cartilage is durable, but it has drawbacks such as the nose tip becoming stiff, reduced mobility, and the underlying structure showing through if the skin is thin.[5]In a study summarizing 888 rib cartilage surgeries, complications occurred in 7–8% of cases, and 89–92% of patients were satisfied.[6].

When harvesting rib cartilage, an additional incision on the chest is necessary, and pneumothorax (a collapsed lung), pain, scarring, and chest deformity are possible complications.[1]In a report of 47 patients combining septal cartilage and auricular cartilage, natural shape and feel were achieved.[5].

Is the ear shape and scarring acceptable?

After harvesting cartilage from the ear, changes in ear shape have been reported.[7]Complications at the donor site include hematoma (blood accumulation), keloid, and ear deformity.[1].

A report of 60 patients describes reducing ear deformity by preserving the supporting structures of the ear depression during harvest.[7]Which site is used and how much is harvested are points you should clarify beforehand.

Does the thickness of skin at the tip of the nose affect the result?

Yes. In patients with thin skin and weak cartilage, problems such as the grafted cartilage shape becoming visible and asymmetry of the nasal tip are more likely to occur.[2].

Conversely, in thick and firm skin common among Asian patients, even after cartilage shaping, some people do not achieve as fine a nasal tip as desired.[8]Skin thickness is an important factor that determines the quality of the final result.

How do I decide when I'm uncertain?

Amount of change desired: minor refinement or significant heightening[1][2]

Longevity: possibility of height reduction and management options if it occurs[3][2]

Skin thickness: whether shape becomes visible, whether refinement will be difficult to achieve[2][8]

Donor site: consideration of ear deformity and scarring[1][7]

Whether auricular cartilage alone is sufficient for your nasal tip, or if rib cartilage or septal extension is needed, cannot be determined from an article alone. At consultation, communicate how much you wish to change the height and angle, and confirm the skin thickness and the type and amount of cartilage to be used.