Skip to main content

Paranasal Augmentation Using Diced Costal Cartilage for Midface Concavity: A Retrospective Study of 68 Patients



Paranasal augmentation was effective management for midface concavity. Both alloplastic graft (e.g. silicone, porous polyethylene, or expanded polytetrafluorethylene) and autologous tissue (e.g. costal cartilage) were used for paranasal augmentation. The study aims to evaluate the safety and efficacy of paranasal augmentation using diced costal cartilage for midface concavity.


A retrospective review of demographic data and complications was conducted for consecutive patients who underwent paranasal augmentation using diced costal cartilage. A questionnaire was used for investigating the patient’s satisfaction (i.e. overall satisfaction, bilateral alar bases symmetry, improvement of concavity, and foreign body sensation). Patients’ photographs were used to evaluate aesthetic outcomes (i.e. overall satisfaction, bilateral alar bases symmetry, and improvement of concavity) by third-party doctors.


Sixty-eight patients (60 females; mean age, 27.1 ± 8.2 years) were included. During a median follow-up of 6.5 months, costal cartilage migration occurred in 13 (19.1%) patients and partial resorption occurred in 2 (2.9%) patients. Seventy-five per cent of the patients and 98.5% of the doctors reported overall satisfaction. Bilateral alar bases asymmetry by 20 (29.4%) patients, no improvement of concavity by 13 (19.1%) patients, and foreign body sensation by 13 (19.1%) patients were reported. While bilateral alar bases asymmetry was not reported, improvement of concavity was reported in 67 (98.5%) patients by third-party doctors. On both univariate and multivariate analyses, improvement of concavity was significantly associated with patients’ overall satisfaction (p = 0.008 and 0.045, respectively), while bilateral alar bases symmetry and foreign body sensation were not (all p > 0.05).


Paranasal augmentation using diced costal cartilage seems a safe and effective method for midface concavity. Improvement of concavity may be significantly associated with patients’ overall satisfaction.

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

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. Yaremchuk MJ, Israeli D (1998) Paranasal implants for correction of midface concavity. Plast Reconstr Surg 102(5):1676–1684. Discussion 1685

  2. Park JH, Kim JW, Kim SJ (2016) Midfacial soft-tissue changes after paranasal augmentation with porous polyethylene. Facial Plast Surg 32(2):232–237

    Article  CAS  Google Scholar 

  3. Park SB, Kim YI, Hwang DS, Lee JY (2013) Midfacial soft-tissue changes after mandibular setback surgery with or without paranasal augmentation: cone-beam computed tomography (CBCT) volume superimposition. J Craniomaxillofac Surg 41(2):119–123

    Article  Google Scholar 

  4. Yaremchuk MJ, Vibhakar D (2016) Pyriform aperture augmentation as an adjunct to rhinoplasty. Clin Plast Surg 43(1):187–193

    Article  Google Scholar 

  5. Leupe P, Menger DJ (2016) The injectable filler in rhinoplasty: not a complication-free alternative. B-ENT 12(2):137–142

    CAS  PubMed  Google Scholar 

  6. Lupo G (1997) The history of aesthetic rhinoplasty: special emphasis on the saddle nose. Aesthetic Plast Surg 21(5):309–327

    Article  CAS  Google Scholar 

  7. Ortiz Monasterio F, Ruas EJ (1989) Cleft lip rhinoplasty: the role of bone and cartilage grafts. Clin Plast Surg 16(1):177–186

    Article  CAS  Google Scholar 

  8. de la Pena-Salcedo JA, Soto-Miranda MA, Lopez-Salguero JF (2012) Intranasal surgical approach for malar alloplastic augmentation. Aesthet Surg J 32(1):27–38

    Article  Google Scholar 

  9. Colonna M, Cavallini M, De Angelis A, Preis FW, Signorini M (1996) The effects of scalp expansion on the cranial bone: a clinical, histological, and instrumental study. Ann Plast Surg 36(3):255–260. Discussion 260–252

  10. Daniel RK, Calvert JW (2004) Diced cartilage grafts in rhinoplasty surgery. Plast Reconstr Surg 113(7):2156–2171

    Article  Google Scholar 

  11. Kreutzer C, Hoehne J, Gubisch W, Rezaeian F, Haack S (2017) Free diced cartilage: a new application of diced cartilage grafts in primary and secondary rhinoplasty. Plast Reconstr Surg 140(3):461–470

    Article  CAS  Google Scholar 

  12. Erol OO (2017) Injection of compressed diced cartilage in the correction of secondary and primary rhinoplasty: a new technique with 12 years’ experience. Plast Reconstr Surg 140(5):673e–685e

    Article  CAS  Google Scholar 

  13. Qiao C, Yu W, Gao W, Qiu Y, Lin X (2020) A simple combination approach for costal cartilage augmentation rhinoplasty. J Craniofac Surg 31(2):340–342

    Article  Google Scholar 

  14. Daniel RK (2008) Diced cartilage grafts in rhinoplasty surgery: current techniques and applications. Plast Reconstr Surg 122(6):1883–1891

    Article  CAS  Google Scholar 

  15. Liang Y, Wang X (2020) Application of diced autologous rib cartilage for paranasal augmentation in cleft nose. Aesthet Plast Surg 45:1169–1175

    Article  Google Scholar 

  16. An Y, Zhen Y, Ye W, Cui Y, Dang W, Zhao J et al (2021) Diced costal cartilage graft combined with muscle repositioning improves Cleft-Side Alar asymmetry in Asian secondary unilateral cleft rhinoplasty: a three-dimensional evaluation. J Plast Reconstr Aesthet Surg 74:2265–2271

    Article  Google Scholar 

  17. Cerkes N, Basaran K (2016) Diced cartilage grafts wrapped in rectus abdominis fascia for nasal dorsum augmentation. Plast Reconstr Surg 137(1):43–51

    Article  CAS  Google Scholar 

  18. Moon BJ, Lee HJ, Jang YJ (2012) Outcomes following rhinoplasty using autologous costal cartilage. Arch Facial Plast Surg 14(3):175–180

    Article  Google Scholar 

  19. Ledo TO, Ramos HH, Buba CM, Webster G, de Lima Jr JT, de Paiva DL et al (2020) Outcome of free diced cartilage grafts in rhinoplasty: a systematic review. Facial Plast Surg 37:117–121

  20. Lu SM, Bartlett SP (2014) On facial asymmetry and self-perception. Plast Reconstr Surg 133(6):873e–881e

    Article  CAS  Google Scholar 

  21. Sozen T, Dizdar D, Goksel A (2021) Awareness of facial asymmetry and its impact on postoperative satisfaction of rhinoplasty patient. Aesthet Plast Surg 45(1):214–220

    Article  Google Scholar 

  22. Lee TY, Chung HY, Dhong ES, Jeong SH, Han SK (2019) Paranasal augmentation using multi-folded expanded polytetrafluorethylene (ePTFE) in the east asian nose. Aesthet Surg J 39(12):1319–1328

    Article  Google Scholar 

  23. AlHarethy S, Al-Angari SS, Syouri F, Islam T, Jang YJ (2017) Assessment of satisfaction based on age and gender in functional and aesthetic rhinoplasty. Eur Arch Otorhinolaryngol 274(7):2809–2812

    Article  Google Scholar 

Download references


We would like to thank the patients for providing consent for the publication of these cases.


This study was funded by the Foundation of the Chinese Academy of Medical Sciences-Plastic Surgery Hospital (3060120043).

Author information

Authors and Affiliations



WD is responsible for the design of the study, acquisition of data, analysis, and interpretation of data and drafting the manuscript. YX and RZ participated in the discussion and revision of the manuscript. RH participated in artworks production and revision of the manuscript. FF is responsible for designing the study, revising the manuscript and final approval of the version to be published.

Corresponding author

Correspondence to Fei Fan.

Ethics declarations

Conflict of Interest

The authors declare that there is no conflict of interest regarding the publication of the paper.

Human or Animal Rights

All procedures performed in studies involving the human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

For this type of study, informed consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Dong, W., Xu, Y., Han, R. et al. Paranasal Augmentation Using Diced Costal Cartilage for Midface Concavity: A Retrospective Study of 68 Patients. Aesth Plast Surg 46, 795–802 (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Midface concavity
  • Paranasal augmentation
  • Diced costal cartilage
  • Rhinoplasty