The use of graft materials in rhinoplasty presents many challenges for the surgeon. There are a wide variety of alloplastic materials available for nasal augmentation but the graft material of choice remains autologous cartilage. It has considerable advantages over alloplasts. It does not induce an immune response and has a very much lower rate of infection or extrusion. It is also easily harvested and sculpted and is available in plentiful supply. We present a retrospective review of 103 patients who underwent augmentation rhinoplasty using autologous cartilage grafts with a mean follow-up time of three years six months. The revision rate over the follow-up period was 15.5 per cent (n = 16). The same surgeon’s revision rate for rhinoplasty without graft over the same period was four per cent in 311 cases. We conclude that while autologous cartilage remains the best graft material available there is a significantly higher revision rate than when no graft is required. This is primarily due to the unpredictable scarring associated with the graft in the medium term and the asymmetric nature of conchal cartilage.