Fresh Frozen vs. Autologous Costal Cartilage in Rhinoplasty: A Meta-analysis of Complication Rates

Background Fresh frozen costal cartilage (FFCC) has emerged as a promising alternative to autologous costal cartilage (ACC) in structural rhinoplasty, offering advantages such as elimination of donor site morbidity and reduced operative time. However, concerns remain regarding its complication profile compared to ACC. Objectives This meta-analysis compares postoperative complication rates between FFCC and ACC in rhinoplasty, focusing on infection, warping, resorption, and revision surgery. Methods A systematic review was performed according to PRISMA guidelines. MEDLINE, Embase, Web of Science, and Scopus were searched for studies published between January 1990 and March 2025. Eligible studies reported outcomes of rhinoplasty using FFCC or ACC in cohorts of ≥5 patients. Data were extracted on complication rates, patient demographics, follow-up duration, and study characteristics. Risk of bias was assessed using the ROBINS-I tool. Pooled complication rates and 95% confidence intervals (CI) were calculated. Differences between graft types were assessed using unpaired two-proportion z-tests. Results Twenty-seven studies met inclusion criteria, encompassing 2,137 patients in the ACC group and 766 in the FFCC group. The weighted mean follow-up was 18.4 months for ACC and 23.0 months for FFCC. FFCC was associated with significantly lower rates of warping (1.2% vs. 3.9%; p = 0.00038) and revision surgery (1.3% vs. 3.4%; p = 0.0029). Infection (1.7% vs. 2.3%; p = 0.34) and resorption rates (1.2% vs. 1.9%; p = 0.25) were not significantly different between groups. Conclusions FFCC demonstrates significantly lower rates of warping and revision surgery compared to ACC, with no increase in infection or resorption. Despite limitations related to study design and follow-up duration, these findings support FFCC as a safe and effective alternative to autologous grafts in rhinoplasty. Further prospective, controlled studies are needed to confirm these results and evaluate long-term outcomes.