Outcomes and complications of autologous versus alloplastic grafts in augmentation rhinoplasty: A systematic review of studies from 2000 to 2024

Background Augmentation rhinoplasty requires careful selection of graft material to achieve aesthetic and functional success. Autologous cartilage and alloplastic implants remain the most widely used options, each with distinct advantages and risks. Methods A systematic review was conducted of studies published between 2000 and 2024. Eligible designs included randomized controlled trials, cohort and case–control studies, and large case series (≥10 patients). Three databases (PubMed, Embase, and Scopus) were searched in accordance with PRISMA 2020 guidelines, and full search strategies are provided in the appendix for reproducibility. No PROSPERO registration was undertaken; however, a predefined protocol was followed to ensure transparency and methodological rigor. Risk of bias was assessed using RoB 2 for randomized trials and ROBINS‑I for observational studies. Results Twenty‑eight studies met inclusion criteria, representing diverse geographic regions and graft practices. Autologous grafts, especially costal cartilage, were associated with lower infection and extrusion rates, but carried risks of warping and occasional resorption. Alloplastic implants, most commonly silicone and Gore‑Tex, provided operative efficiency but demonstrated higher infection and extrusion rates, particularly in long‑term follow‑up. Meta‑analysis of 10 studies (n = 7,019) revealed a significantly lower infection risk with autologous grafts (OR = 0.19; 95% CI: 0.09–0.42; p < 0.001). Conclusions Autologous cartilage remains the preferred option for complex, high-risk, or revision rhinoplasty, while alloplastic implants may be appropriate in carefully selected primary cases. Future studies should incorporate standardized patient-reported outcome measures and longer follow-up to improve comparability and clinical relevance.