Tip grafting Tissue Choices
From your post it would seem that you do not have sufficient septal cartilage available for use in a potential revision rhinoplasty procedure. This is not uncommon, however utilizing septal bone as tip graft material is unconventional. The best choices are typically natural cartilage or fascia. Cartilage grafts can be taken from the ear or rib and fascia can be harvested from the temporals fascia or other sites. Often alloplastic materials can serve as good options, including irradiated rib cartilage from a tissue bank donor or Alloderm acellular tissue graft for fascia. In my view, cartilage and/or fascia options would be your best grafting option. Perhaps you should reconsider your refusal to consent to these choices. However, with regards to your question about leaving a "hole" in your septum if you harvest septal bone, if performed properly this should not result in a septal perforation. The lining of your septal mucosa should remain intact and stay healthy after septal bone is harvested. I am glad that you are researching your options for revision grafting material. Since you have had multiple rhinoplasties in the past, your risk of complications increases with each added revision. Bone grafts have certain risks that you should discuss in detail with your surgeon. Hope this answer helps.