Details on Removing/Replacing Septum in Rhinoplasty?

You ask an excellent question. When we harvest septal cartilage for nasal grafting, we always leave behind a large piece (>1cm) at the bridge, and low down by the columella to maintain support of your nose. As long as this structural cartilage is maintained, the harvested cartilage does not need to be replaced.

I hope this is helpful for you.

This is a good question.  As others have commented, usually only only  cartilage that is deviated or needed for grafting  is removed from the septum.  The remaining cartilage along the bridge and between the nostrils must be strong enough to support the nose.  I routinely replace any cartilage that is not used back between the septal lining tissue, usually after it has been lightly crushed.  This helps provide support to the septum where cartilage was harvested, and it can help prevent a septal perforation if there was any damage to the lining tissue.  Additionally, this cartilage can then be harvested again in the future and used for grafting if necessary.  Rarely, if the cartilage in the "L-strut" area is twisted beyond repair, it can be completely removed from the septum, straightened and then replaced.  I have done this numerous times and it works very well. 

Nasal Septal cartilage is routinely harvested in order to fashion cartilage grafts for shaping or strengthening the nose.  However, an L shaped septal strut with at least 1 cm in thickness is typically left in place and intact for purposes of nasal support.  It is rare for the entire septum to be removed and replaced unless the patient has had severe trauma to the nose.

In general, most surgeons experienced in rhinoplasty will only remove deviated portions of the septum.  If you need grafting, which most patients require, additional septal cartilage will be harvested for this purpose.  You cannot removal too much septal cartilage or the nose will collapse.  If you require significant amounts of cartilage for grafting purposes, ear or rib cartilage may be harvested.  Cartilage remnants can then be crushed and returned to the septum to increase support.  It would be an exceedingly rare event to remove the entire septum for repair (although this can be done if warranted).  I recommend a surgeon who specializes in rhinoplasty and is Board Certified by The American Board of Facial Plastic and Reconstructive Surgery.  Warmest regards, Dr. Pippin.

Hi beckaD in 90210,

Rhinoplasty is not one operation, but many potential operations. Every patient is unique. The nasal septum is the foundation of the nose, affecting not only nasal breathing but also appearance. Rhinoplasty surgeons typically only use a small portion of the septum to obtain enough cartilage graft material. Cartilage removed from the septum for grafting typically does not need to be replaced. Septal cartilage is also often removed during septoplasty, or deviated septum surgery. Only after a comprehensive evaluation by a rhinoplasty surgeon can he/she determine appropriate options for you. Best of luck.

When using the septum for cartilage grafts, a strut of the cartilage is left in palce to provide nasal support. The entire septum is not usually harvested.

Nasal septum is the key stone structure of the nose and  excessive removal will result in collapse or distortion of the nose. As long as the surgeon maintains a good L-shaped strut of septal  cartilage to provide support anteriorly and caudally( inferiorly)during cartilage harvesting from the septum no harm will occur. An experienced surgeon will know how much to take and leave behind.

An experienced doctor in doing septum's has his own technique. The septum is usually not removed and replaced. It is shaped so it is straight. Sometimes cartilage is removed and sometimes it is just trimmed and straighted - depends on the docs techniques -- ask him.

The septum is an excellent choice for cartilage grafting in rhinoplasty because the area borrowed from is invisible, and the cartilage is of the best quality for support or visible grafts. Of course, there is a limit as to what the septum can supply. A good measure of the septum must be left for support of the bridge and the lower end of the nose, and with good planning the portion borrowed will not be missed.
Best of luck,
peterejohnsonmd

Hi becka,

Typically, most experienced rhinoplasty surgeons will only remove as much septal cartilage as they need for grafting. This cartilage is removed from further back in the septum where it will not be missed. We are sure to leave a strong area of cartilage at the front and top of your septum to maintain support and shape. If there is some cartilage left over after grafting, some surgeons may return it to the septum and others do not as they do not want it to potentially move and cause obstruction. It is a personal preference for the surgeon that is not critical to the outcome. It is not necessary to replace septal cartilage with cartilage from anywhere else.

All the best,