SEPTUM
THE SEPTUM IS THE KEY STRUCTURAL SUPPORT PIECE OF THE NOSE.
It is composed of both cartilage in the front, and bone in the back. It is VERY common for humans to have a deviated septum, however, this is not always clinically significant. Some patients have major deviations with very little obstruction, and some have minor deviations that cause a greater degree of obstruction. The nasal septum can be deviated in many different ways, each requiring different techniques to correct.
More severe septal problems include a broken septum (septal fracture), and a hole in the septum (perforation). These challenging configurations require much more advanced and complex surgery to correct, often including using rib cartilage and/or fascia from the scalp.
RIB
Rib grafting is often used in both revision rhinoplasty, and noses that have suffered trauma.
The graft is made from cartilage, not bone. This is typically harvested from the right chest, 2-3 inches below the breast fold. On average, the incision is 15-22mm in size, depending on body habitus.
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In the early periods, the harvest site can be sore for 1-2 weeks. The scar is initially red, then transitions from pink to a thin white line. The scar continues to fade for 2 years.
Rib cartilage is critical in building structure in rhinoplasty. This can be used for any of the below
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Spreader grafts
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Tip cartilage reconstruction
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Septal extension grafting
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Total septal reconstruction
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Dorsal augmentation ​
EAR CARTILAGE
Ear cartilage is used very infrequently in rhinoplasty in our practice. This is due to the fact that ear cartilage is both soft and thick. In the nose, we want cartilage that is thin and strong. This is what allows us to both open the airways, while not simultaneously adding excessive size or width to the nose. Rarely, ear cartilage can be used for "camouflage".
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If used, it is taken from a small incision in the front of the ear. This causes no changes to the function or the appearance of the ear and is typically invisible by 4-6 weeks.
COMPOSITE GRAFTS
Composite grafts are occasionally used in rhinoplasty, particularly in revisions. Nostril asymmetry in revision surgery is commonly due to post surgical alar retraction (scar tissue forming inside the nose). In order to correct this, you MUST both bring the nostril down with strong cartilage grafts, and also replace the skin inside the nose with a composite graft.
These grafts are harvested from the front of the ear, deep inside the bowl. Once healed, the scar is imperceivable. This does not change the shape, color, size, or function of the ear.
Typical appearance of the scar at 6 months. It is imperceivable by 4-6 weeks on average
FASCIA
Fascia, or the lining of muscle tissue, is a very useful tissue in Rhinoplasty. Its primary purpose is for camouflage, but it also has utility in the repair of septal perforations. There are 2 primary types of Fascia
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Rectus Fascia
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Temporalis Fascia (Deep Temporal Fascia)
Rectus fascia is obtained from the rectus abdominis muscle. This is encountered when harvesting rib grafts, and from the same incision.
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Temporalis fascia is obtained from the temporalis muscle. This is harvested from an incision 1 inch above the right ear.
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The harvest of either of these tissues causes mild and temporary discomfort with movement of the muscle (activation of abdominal muscles, or chewing). It does not cause any permanent dysfunction of these muscles, and it regenerates.
