Aesthetic Plastic Surgery

, Volume 42, Issue 3, pp 854–858 | Cite as

The Cartilage Warp Prevention Suture

  • Bahman Guyuron
  • Derek Z. Wang
  • David E. Kurlander
Original Article Rhinoplasty



Costal cartilage graft warping can challenge rhinoplasty surgeons and compromise outcomes. We propose a technique, the “warp control suture,” for eliminating cartilage warp and examine outcomes in a pilot group.


The warp control suture is performed in the following manner: Harvested cartilage is cut to the desired shape and immersed in saline to induce warping. A 4-0 or 5-0 PDS suture, depending the thickness of the cartilage, is passed from convex to concave then concave to convex side several times about 5–6 mm apart, finally tying the suture on the convex side with sufficient tension to straighten the cartilage. First an ex vivo experiment was performed in 10 specimens from 10 different patients. Excess cartilage was sutured and returned to saline for a minimum of 15 min and then assessed for warping compared to cartilage cut in the identical shape also soaked in saline. Then, charts of nine subsequent patients who received the warp control suture on 16 cartilage grafts by the senior author (BG) were retrospectively reviewed. Inclusion of study subjects required at least 6 months of follow-up with standard rhinoplasty photographs. Postoperative complications and evidence of warping were recorded.


In the ex vivo experiment, none of the 10 segments demonstrated warping after replacement in saline, whereas all the matching segments demonstrated significant additional warping. Clinically, no postoperative warping was observed in any of the nine patients at least 6 months postoperatively. One case of minor infection was observed in an area away from the graft and treated with antibiotics. No warping or other complications were noted.


The warp control suture technique presented here effectively straightens warped cartilage graft and prevents additional warping.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Rhinoplasty Costal cartilage graft Graft warping Warp control suture 


Compliance with Ethical Standards

Conflict of interest

The authors have no financial or non-financial interests in the products or materials used in this study.

Human Subjects Protection

Institutional review board approval was granted for this study. The guidelines in the Declaration of Helsinki were followed at all points during this study.

Supplementary material

266_2017_1052_MOESM1_ESM.mp4 (99.7 mb)
Supplementary material 1 (MP4 102141 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2018

Authors and Affiliations

  • Bahman Guyuron
    • 1
  • Derek Z. Wang
    • 2
  • David E. Kurlander
    • 1
  1. 1.Case Western Reserve University Plastic SurgeryCleveland, LyndhurstUSA
  2. 2.Case Western Reserve University School of MedicineClevelandUSA

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