Septal Bony Paste Graft: A Life-Saving Material in Rhinoplasty Camouflage

Overview

Cartilage is the preferred material for both structural grafting and camouflage, but after it has been used for structure there is sometimes none left for camouflage. The author proposes preparing the bony parts of the septum as a paste for that purpose. Patients treated between April 2018 and December 2019 were reviewed retrospectively.

Sections of note

• Retrospective review of 62 patients; the journal assigns level of evidence IV.
• Fifty six patients were female and 6 male; average age 28 years, range 18 to 52.
• Follow up ranged from 12 to 29 months, mean 20.5 months.
• The paste was prepared using a micro rasp attached to a motor system.
• It was used to camouflage bone cut lines in 59 patients.
• It was used for smoothing the bridge in 47 patients.
• It was used to camouflage tip grafts in 36 patients and bridge onlay grafts in 21.
• No serious functional or aesthetic complications related to the paste were encountered.

What it means for a patient

• The bony part of the septum is normally discarded; this technique reuses it as filler material.
• That avoids taking additional cartilage from the ear or rib purely for camouflage.
• Its most common use was hiding the ridges left where the nasal bones were cut.
• Sixty two patients from one surgeon with no comparison group and no measured outcome beyond absence of complications is limited evidence.

Why this paper matters

Cartilage supply limits what a rhinoplasty can achieve, and using it for camouflage competes with using it for support. This technique repurposes material already removed. Whether the bone paste resorbs or remains palpable over the longer term is not addressed.

Terms

• Camouflage: concealing edges and irregularities with a soft covering layer.
• Bony septum: the bone forming the rear and lower parts of the nasal partition.
• Paste graft: material ground into a paste so it can be spread over a surface.
• Micro rasp: a fine powered file used to grind bone.
• Osteotomy line: the ridge left where a bone was cut.
• Onlay graft: material laid on the bridge to add height.