Grafting in Rhinoplasty: A Survey of Surgeon Preferences When Donor Material Is Limited

Overview

Structural integrity determines functional results in nasal reconstruction, and surgeons are often limited by how much donor material is available. The authors surveyed members of The Rhinoplasty Society, asking them to prioritize five donor materials across ten common graft types when supply is scarce.

Sections of note

• Design: survey of members of The Rhinoplasty Society. 47 surveys were completed.
• Materials ranked: synthetic implant, septal, rib, ear and cadaveric cartilages.
• Ten graft types were covered, including alar batten, septal extension, columellar strut, dorsal onlay, lateral crural strut, radix, spreader, subdomal, tip onlay and umbrella grafts.
• Septal extension grafts were the first priority given limited septal, rib, fresh frozen donor or irradiated donor cartilage.
• Tip onlay grafts were prioritized when only ear cartilage was available; dorsal onlay when only synthetic material was.
• General preference order: septal cartilage first, then rib, fresh frozen rib, ear, irradiated cadaveric and synthetic material, with deviations for lateral crural strut, lateral crural onlay and alar batten grafts.
• Stated conclusion: rib and fresh frozen donor cartilage are favored for structural support, while ear cartilage is preferred for contour.

What it means for a patient

• The septal extension graft, which sets tip position, is what surgeons build first when material is scarce, ahead of everything else.
• The split is between stiffness and shape: rib for support, ear for the curved grafts along the nostril rim.
• Synthetic material ranked last across nearly every graft type.
• Limits: 47 respondents from one professional society, recording stated preference rather than outcomes, with no evidence that the preferred choices perform better.

Why this paper matters

Deciding what to build when there is not enough cartilage is a routine problem with no published guidance, and trainees currently learn it case by case. Documenting a consensus ordering gives a starting framework. It reflects collective opinion, not measured performance of any material.

Terms

• Septal cartilage: the cartilage of the wall dividing the two sides of the nose.
• Costal cartilage: cartilage from the ribs, harvested for use as a graft.
• Conchal cartilage: cartilage from the bowl of the ear.
• Alloplastic material: an implant made from synthetic material.
• Septal extension graft: cartilage fixed to the septum that carries the tip in a set position.
• Lateral crural strut graft: a cartilage strip placed under the nostril rim cartilage to support it.