Abstract Background Autologous costal cartilage (ACC) is commonly used for dorsal augmentation rhinoplasty due to its availability and strength, despite risks like hypertrophic scarring and pneumothorax for the patient. Irradiated homologous costal cartilage (IHCC) offers an alternative, potentially mitigating these complications. Previous reviews comparing these materials have been methodologically weak. Objectives Our aim was to perform a robust systematic review and meta-analysis comparing the outcomes of ACC and IHCC in dorsal augmentation rhinoplasty to guide clinical decision-making in nasal reconstruction. Methods MEDLINE, EMBASE, Google Scholar, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched. Data extraction and quality assessment were performed by two independent authors. The primary outcomes of interest were warping, revision rates, infection rates, and displacement. Methodological quality and risk of bias were assessed using GRADE and Cochrane’s ROBINS I tool, respectively. Results Thirty-six articles were reviewed, including one comparative and thirty-five single-arm studies (ACC: 29, IHCC: 8), encompassing 2,526 patients from 13 countries. Adverse events included warping (ACC: 6%, p<0.0001; IHCC: 6%, p<0.0001). Resorption rates were 1% for ACC (p = 0.06) and 3% for IHCC (p < 0.0001). Revision surgery rates were similar (ACC: 4%, p<0.001; IHCC: 4%, p<0.001), as were infection rates (ACC: 1.8%, p=0.03; IHCC: 1.3%, p=0.03). Conclusions Current evidence does not demonstrate the superiority of ACC or IHCC for dorsal augmentation rhinoplasty. Both grafts are viable, with the choice guided by patient and surgeon preferences. Prospective, high-quality data with standardized outcomes are needed to improve clinical decision-making.
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