Single-stage Septal Framework Reconstruction After Alloplastic Implant Failure Using Autologous Costal Cartilage

Porous polyethylene implants are widely used in rhinoplasty but are associated with complications, including infection, extrusion, and framework destruction. Managing such complications is challenging, often requiring staged reconstruction. Autologous costal cartilage remains the gold standard for structural support due to its durability and biocompatibility. We reported 2 cases of severe nasal deformity following the use of porous polyethylene implants. Both patients underwent single-stage removal of the implants with immediate septal framework reconstruction using autologous costal cartilage harvested from the eighth rib. Fixation was achieved with a triple transosseous suture through a single bony tunnel in the nasal spine. Outcomes were assessed clinically and with validated patient-reported outcome measures, including the FACE-Q and Rhinoplasty Outcome Evaluation. Patient 1 (34 years old) was followed up for 12 months; patient 2 (36 years old) was followed up for 6 months. Both remained infection-free after surgery. FACE-Q scores improved from an average of 2.4 preoperatively to 4.0 postoperatively. Rhinoplasty Outcome Evaluation scores improved from 7 out of 24 to 20 out of 24 in patient 1 and from 9 out of 24 to 21 out of 24 in patient 2. No graft resorption, structural compromise, or revision procedures were observed. Aesthetic outcomes were stable, and functional breathing improved in both cases. Single-stage autologous costal cartilage reconstruction after implant failure is safe and effective, even in cases with active infection. This approach restores both function and aesthetics without staged procedures or revision surgery.