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.