Can a crooked septum be fixed successfully using ear cartilage? Is it too soft to use on the septum? (photo)

Question

Hello, I was told by a surgeon that I could fix my crooked septum (when a shadow falls, one side of my nose looks like it has a chunk missing, aka pinched on one side) either by full correction of the septum or by cartilage grafting from my ear. I breath ok, so I chose the cartilage grafting. But I now read that ear cartilage is too soft to use on the septum and is better for shaping the tip. Could someone please comment on this? Can a crooked septum be fixed successfully this way?

Lucian Ion, FRCS · Answer

Thank you for your question and sharing your photo.

The first thing that springs to mind is: Be careful what you wish for!

The procedure that you are referring to is a camouflage intervention and as such ear cartilage could offer reasonable contouring. Whether it is solid graft or diced graft there are still risks of contour irregularities.

The most important aspect though is that you are nasal shape has a degree of detailing and definition in the middle third which would be lost. If both sides look like the left side the width of the bridge and the tip will be relatively even with nothing to break the contour continuity. This can produce the impression of exaggerated nasal bridge width.

I suggest testing the hypothesis that you would like the outcome through a temporary intervention -an injectable filler. If you like the effect that the filler has on the shape of the nose, take some photographs and confirm with the surgeon that this is the plan of action. If you find that your nose appears too wide, you can dissolve the filler.

In my experience, nasal shapes like in your photograph are better addressed through a full rhinoplasty intervention to produce a balance of the features in combination with symmetry.

There is unfortunately some peculiarity to asymmetry as it can be both an advantage through the perception of the definition and disadvantage through the differences in shape from the front and oblique views. Unfortunately, the advantage is usually noticed when the characteristics have changed and it is no longer present. It is better to avoid falling into this trap.

Ronald J. Edelson, MD · Answer

Ear cartilage is quite soft. It is possible that your surgeon was talking about using the ear cartilage under the skin to achieve symmetry, not placing it directly on the septal cartilage

Robert Ciardullo, MD · Answer

Can ear cartilage be used to correct a deviated septum? when people have a visible concavity on one side of the nose but breathe OK one can cosmetically correct the concavity by placing a Cartilage graft under the skin filling in the concavity. This is called an onlay graft. Ear Cartlidge is frequently used for this purpose. You probably interpret him as using the ear Cartlidge to straighten the crooked septum, but I don’t think that is the intention. As one plastic surgeon one said “I cannot make your nose straight but I can make it look straight“. So the ear Cartilage is probably going to be used as an onlay graft not as a spreader graft to be applied to the septum itself. If he were doing work on your septum and needed better Cartilage for that he could harvest the Cartilage from your own septum. But since you breathe well an onlay graft using your Ear cartilage is the least invasive and most effective way to fill in a concavity. It could even be done under local anesthesia.

Jeffrey C. Hamm, MD - Account Suspended · Answer

Hi and welcome to our forum!
The oblique view of the lower half of your nose appears to demonstrate a shadow cast at the middle 1/3. As I don't have a frontal view of the entire nose or the benefit of an internal nasal examination, I can't determine the nature of septal involvement as the fullness on the right may also represent an old out fracture of the right nasal bone. There is also a shadow cast on the right side of the nasal tip suggesting fullness of the tip cartilages (or just a shadow).
Cartilage grafts are used to provide support or to fill in contour defects. If used in a supportive role, thick cartilage is required. If used as an overlay graft to correct a contour depression, ear cartilage is satisfactory.
Best wishes...

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