BACKGROUND:The adoption of homologous costal cartilage (HCC) in rhinoplasty is hindered by conflicting reports on resorption and warping. Current literature often conflates fresh-frozen and irradiated grafts, obscuring distinct biological profiles. The objective of this systematic review and meta-analysis was to evaluate the clinical and biomechanical outcomes of different preparations of cadaveric costal cartilage compared to autologous rib cartilage in rhinoplasty. METHODS:A systematic review was conducted per PRISMA 2020 guidelines (PROSPERO ID: CRD42025603758). Studies comparing homologous grafts versus autologous costal cartilage were stratified into fresh-frozen and irradiated subgroups. Primary outcomes compared these homologous subgroups explicitly against autologous cohorts regarding resorption, warping, and infection. Risk of bias was assessed using the Newcastle-Ottawa Scale and ROBINS-I tools. RESULTS:Seven studies comprising 1,184 patients were included. Pooled analysis showed comparable infection rates between groups (risk ratios [RR] = 0.701; 95% CI: 0.284 to 1.731). Stratified subgroup analysis revealed that alcohol-preserved grafts demonstrated a significant reduction in warping risk (RR = 0.106; 95% CI: 0.012 to 0.934), while fresh-frozen and irradiated preparations showed comparable warping to autologous controls. Conversely, an elevated risk of resorption was driven exclusively by the irradiated subgroup (RR = 4.595; 95% CI: 1.279 to 16.503), whereas fresh-frozen (RR = 1.588; 95% CI: 0.489 to 5.164) and alcohol-preserved (RR = 1.479; 95% CI: 0.313 to 6.998) subgroups showed no significant difference. Operative time was significantly reduced in the homologous cohort (weighted mean differences = -66.56 min; 95% CI: -81.42 to -51.71). CONCLUSION:HCC represents a viable alternative to autologous rib in carefully selected cases, rather than a default substitute. While modern preservation methods offer promising short-term structural stability and eliminate donor-site morbidity, the decision of graft choice may be best made from individual patient and surgical factors, rather than the superiority of one source over the other.
BACKGROUND:Fresh frozen costal cartilage allografts are used in rhinoplasty, but their biomechanical and biochemical properties remain under-characterized. OBJECTIVE:To determine whether cut orientation, harvest location, or irradiation status influences the biochemical, mechanical, and warping properties of a commercial fresh frozen costal cartilage allograft. METHODS:Biochemical assays, three-point bending, and warping assessments were performed. Mixed-effects and linear regression models assessed associations with orientation, harvest location, and irradiation status. Intraclass correlation coefficients quantified donor-level variability. RESULTS:Twenty-one specimens from 9 donors (mean age 43.1 years, 78% male, 44% irradiated) yielded 66 biochemical assays, 16 bending tests, and 143 warping observations. Collagen, sulfated glycosaminoglycan (sGAG), and collagen-to-sGAG ratio did not differ between cortical and medullary cartilage (p ≥ 0.55). DNA was lower in medullary samples (p = 0.02; ICC = 0.73). Elastic and flexural moduli did not differ by harvest location or irradiation status (p > 0.35). Median 60-min warping angle was 8.15° (IQR 5.76-11.26°). Median plateau time was 37.2 min, with 94% stabilizing within 45 min. The 15-minute warping angle was the strongest predictor of final graft geometry (coefficient 0.917, p < 0.001). CONCLUSION:In this study, donor-level variation tended to exceed the effects of cut orientation, harvest location, or irradiation status.
Background: Extracellular vesicle (EV)-based therapies have emerged as a novel modality in aesthetic medicine due to their proposed ability to modulate inflammation, stimulate collagen synthesis, and promote tissue regeneration. Objectives: To systematically evaluate the effectiveness and safety of EV-based interventions for nonsurgical facial rejuvenation in adult patients. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-adherent systematic review was conducted using MEDLINE, EMBASE, CENTRAL, Web of Science, and ClinicalTrials.gov (January 2000–June 2025). Eligible studies investigated EV therapies for facial rejuvenation outcomes. Risk of bias and methodological quality were assessed using tools appropriate to the study design. Certainty of evidence was evaluated using GRADE. Due to substantial heterogeneity, results were synthesized narratively. Results: Sixteen studies encompassing 503 participants were included, comprising split-face studies, comparative trials, and single-arm studies. Most studies reported improvement in at least one skin quality outcome, including wrinkle severity, pigmentation, hydration, elasticity, or overall appearance. Comparative studies generally favored EV-treated areas. No serious adverse events were reported. Risk of bias was moderate to critical for most effectiveness outcomes. GRADE certainty was low or very low. Conclusions: EV-based therapies demonstrate preliminary signals of benefit and short-term safety for facial rejuvenation. However, methodological limitations, inconsistent outcome assessment, and short follow-up preclude definitive conclusions.
Background: Cross-face nerve grafting is widely performed in smile reanimation, but its application in dynamic blink restoration is less well characterized. Objectives: To compare axon counts of the frontal, zygomatic, and periorbital branches of the facial nerve in human anatomical specimens to provide insight on their suitability in cross-face nerve grafting surgery. Methods: Four human anatomical specimens (eight hemifaces) were dissected. Facial nerve specimens were processed for histological cross-sectional analysis using FluoroMyelin staining. Quantitative axon analysis was conducted using semiautomated dot annotation in opensource QuPath software. Axon counts were compared using one-way analysis of variance (ANOVA). Results: The study included four male human anatomical specimens with an average age of 71 years. Mean axon counts were 405.0 for the frontal branch, 367.4 for the zygomatic branch, and 285.8 for the orbicularis branch. Substantial variability was observed across specimens. ANOVA did not detect a difference in mean axon count ( p = 0.0757). Lateral orbicularis oculi branches were identified in all hemifaces and commonly arose directly from the upper facial nerve trunk. Conclusion: This study demonstrates that sampled frontal, zygomatic, and orbicularis oculi facial nerve branches had axon counts that were not detectably different in this human anatomical specimen cohort.
BACKGROUND:Specific allograft processing methods may contribute to high failure rates. OBJECTIVES:To characterize commonly used proprietary costal cartilage allograft processing techniques among tissue banks and assess surgeon preferences for graft sterilization methods in rhinoplasty. METHODS:A comprehensive review of American Association of Tissue Banks (AATB)-certified cartilage providers was performed using public databases, United States Patent and Trademark Office records, PubMed, and consultation with research scientists. An international survey of rhinoplasty surgeons in the Evidence-Based Rhinoplasty Reading Group assessed allograft preferences for rhinoplasty. RESULTS:Among 41 AATB-certified cartilage providers, 12 distinct proprietary processing protocols were identified. Gamma irradiation (1.0-5.0 Mrad) was used in 63.6% of methods. Peroxide-based detergents, including hydrogen peroxide, were used in 36.4%, and alcohol-based detergents, including isopropyl alcohol, in 36.4%. Antibiotic or aseptic solutions (bacitracin, polymyxin B, gentamicin) were incorporated in 45.4% of protocols. Survey respondents favored fresh-frozen costal cartilage allograft, although most surgeons (74.6%) reported exclusive use of autologous costal cartilage. CONCLUSIONS:Substantial heterogeneity exists in costal cartilage allograft processing methods and surgeon selection preferences. Variability in processing may contribute to differences in reported clinical outcomes. Greater understanding of these methods may guide future research and support evidence-based graft selection.
BACKGROUND:Rhinoplasty surgeons lack a universal scale of the relative difficulty of rhinoplasty techniques and rhinoplasty deformities. OBJECTIVE:To compare the expert opinion of the difficulty of rhinoplasty techniques and rhinoplasty deformities among international rhinoplasty surgeons, as measured by a scale of difficulty. METHODS:A cross-sectional survey of rhinoplasty surgeons collected training levels, experience, case volume, and perceived expertise. Rhinoplasty techniques/deformities (n = 64) were rated from 1-10, representing the least to most technically demanding. Rasch analysis was used to examine the fit of the observed data to Rasch model requirements, assess rating scale functioning, and provide estimates of internal consistency. RESULTS:Respondents (n = 63) were in practice (<5 years, 14%; 5-10, 20%; 10-20, 20%; 20-30, 26%; >30, 20%), and rhinoplasty volume ranged from <25 (14%) to >100 cases/year (32%). Self-reported expertise was comfortably novice (32%), intermediate (10%), advanced (28%), and expert (30%). Otolaryngology (42%), facial plastic surgery (30%), and plastic surgery (28%) were represented. Rasch estimates of internal consistency reliability were excellent (0.96 for surgeons and 0.99 for items); the item difficulties were more heterogeneous (mean: 0, SD: 1.23) than the distribution of surgeons (mean: -0.09, SD: 0.58). Survey items were ordered by difficulty, ranging from least difficult (inferior turbinate reduction = 1.01) to most difficult (contracted nose repair post-infection = 8.24). CONCLUSION:The newly developed Rhinoplasty Difficulty Scale provides ratings of common rhinoplasty techniques and deformities with a high correlation among experts using this rating scale.
BACKGROUND:Evaluating cleft lip and/or palate (CLP) surgical outcomes from short-term international surgical outreach in low- and middle-income countries is essential for high-quality care. OBJECTIVE:To quantify reported surgical outcomes and complications on CLP surgery performed during international outreach, as measured by speech results and complications, including wound dehiscence, hemorrhage, and fistula formation. METHOD:A systematic review of PubMed and EMBASE identified full-text English-language studies from 1985 to 2025 describing CLP repair in international outreach. Outcomes were extracted per-patient and per-procedure, including complication rates, speech findings, and patient-reported results. RESULTS:Of 450 studies screened, 34 met inclusion criteria (26,529 patients; 30,864 procedures). The mean follow-up was 14.2 months (range: 1 week-11 years). The pooled complication rate was 3.3% per-procedure (1,015/30,864) and 3.8% per-patient (1,015/26,529). Per-procedure complication rates were 2.1% (285/13,823) for lip and 3.8% (642/16,745) for palate repair. The most frequent overall complications were wound dehiscence (1.3%; 400/30,864), hemorrhage (0.4%; 129/30,864), and infection (0.3%; 102/30,864). Among cleft palate repairs, palatal fistula (1.6%; 271/16,745) and flap necrosis (0.5%; 77/16,745) were most common. Four studies described improved speech, social functioning, and satisfaction postoperatively. CONCLUSION:Short-term CLP surgical outreach demonstrates early complication rates comparable to high-resource settings, although limited follow-up likely underestimates true adverse events.
