Details on Removing/Replacing Septum in Rhinoplasty?

So if my surgeon removes my septum to harvest the cartilage for other areas on my nose, is the septum replaced with cartilage from other areas like the ribs or ear? also, is replacing the septum typically a good idea? i mean does the newly created septum do a good job as far as functionality and holding up and staying straight, etc?

Doctor Answers 11

Details on Removing/Replacing Septum in Rhinoplasty

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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.

Metairie Facial Plastic Surgeon

Septal Cartilage for Grafting in Rhinoplasty

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Only a portion of the septum is removed as a source of cartilage for grafting. Enough cartilage is left in place to maintain septal integrity and support the nasal pyramid. If more cartilage is needed, it is taken from the ears or ribs.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 40 reviews

If septal grafts are harvested properly during rhinoplasty, they will not need to be replaced.

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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.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 429 reviews

Details on Removing/Replacing Septum in Rhinoplasty?

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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. 

Rhinoplasty and Septal Cartilage

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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.

Nasal septal cartilage for #rhinoplasty surgery

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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.

Septum for grafts

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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.

Maintaining the septal support is essential

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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.

Zain Kadri, MD
Los Angeles Facial Plastic Surgeon

There are many different techniques for an SMR

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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 will not miss cartilage taken for grafting

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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,


These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.