Economizing the Septal Cartilage for Grafts During Rhinoplasty, 40 Years' Experience

Gunther S, Guyuron B.

What this paper says

An expert opinion article on using septal cartilage sparingly during rhinoplasty so that a surgeon does not need to take cartilage from the ear or rib.

Overview

Rhinoplasty usually requires cartilage to shape and support the rebuilt nose. The authors state septal cartilage is the ideal graft source because it is easy to reach and of good quality, but the supply inside the nose is limited. The senior author sets out 40 years of experience in getting the most out of that limited supply, mapping which parts of the septum suit which graft and when other sources become necessary.

Sections of note

Opinion and technique article; the journal assigns level of evidence V, the lowest tier.
The abstract reports no patient numbers, no outcomes, no complication rates and no follow up.
Stated purposes are to share the senior author's 40 years of experience with septal cartilage economy.
To identify which areas of the septal cartilage are most suitable for which particular graft.
To discuss the grafts commonly used in rhinoplasty.
To identify when other cartilage sources are needed and where those grafts are best used.
To present an option for preserving leftover septal cartilage.
The concluding recommendation is that graft choice should follow the size, thickness and curvature required by the structural and functional needs of the operation.

What it means for a patient

Cartilage inside the nose is finite, and using it efficiently can avoid an ear or chest incision.
Different regions of the septum have different thickness and curvature, which is why a surgeon selects specific pieces for specific grafts.
This paper carries no data. It records one surgeon's judgment, not a tested method.
Nothing here indicates how often the approach succeeds in avoiding a second donor site.

Why this paper matters

Where the graft comes from determines whether a rhinoplasty involves one surgical site or two, and revision surgery is often limited by cartilage already spent. This article codifies the practice of rationing septal cartilage. Whether it reduces the need for rib or ear harvest has not been measured.

Terms

Septal cartilage: the cartilage forming the central partition inside the nose, the usual first choice for grafts.
Graft: a piece of tissue moved from one place to another to support or reshape.
Level of evidence V: expert opinion, the weakest category of clinical evidence.
Curvature: the natural bend of a cartilage piece, which affects where it can be used.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

From the abstract

“During rhinoplasty, it is typically necessary to use cartilage to shape and support the final nasal construct to provide both form and function to the nose (Tanna et al. in Plast Reconstr Surg 141(1):137e-151e, 2018; Guyuron in Plast Reconstr Surg 105(6):2257-2259, 2000; Kim et al. in Ann Plast Surg 65(6):519-523,…”

Excerpt; the full abstract is on PubMed.