While there is not necessarily a 'best' donor cartilage for structural nasal grafting, I generally prefer nasal septal cartilage. Septal cartilage, when properly harvested during rhinoplasty, is usually plentiful in supply, straight and rigid. There is essentially no donor site morbidity as it comes from the same surgical field that is being worked on already. When septal cartilage is unavailable (previous septal surgery, trauma, drug abuse, etc.), I prefer costochondral (rib cage) cartilage to other sites (ie. ear) as it is perfect for structural grafting in the nose. The only disadvantage in my view is the additional surgical site which in my experience has been only minimally inconvenient for patients. Choosing the right cartilage is all about the nasal requirements. As none of the available donor sites are all that bad for patients to deal with, I prefer to go with the 'best available.' In my practice, there are only very rarely indications for 'onlay' grafting which typically is utilized to 'fill in' visible defects. These grafts are usually crushed or morselized to prevent warping and can be from any donor source. Unfortunately, onlays can resorb or shift. In my secondary and reconstructive rhinoplasty practice in particular (but often in primary rhinoplasty as well), I find structural grafting is essential to maintain the nasal size, shape and orientation. As my rhinoplasty practice has evolved over 15 years, I have moved toward structurally grafting nearly all of my patients and my results have improved and become more sustainable as a result.

Each doctor has their own technique --- I try to use only your own cartilage if I have to graft, but I try just to re-shape what you have there. Someone who has examined your nose will give you the best answer.

Thank you for the question! I usually use septal cartilage for the tip, spreader grafts (dorsum), and ala support when performing cosmetic rhinoplasty. If I am performing an entire nose reconstruction after cancer or a dog bite, I will use rib cartilage for the dorsum and support and ear cartilage for the alas on each side of the nose. I find the ear cartilage from the concha has the nicest shape and contour for the ala reconstructions. Each plastic surgeon has their own preferences based on experience, training, and interpretation of the scientific literature. The usual donor sites are septum, ears, and ribs. All are acceptable.

Septal cartilage is always best if available. It has the required stiffness, thickness and can be shaped for the usual needs of rhinoplasty. For the tip, supporting it starts with preserving as many connections as possible to the upper lateral cartilages and the septum. Since this is not always possible, support is usually augmented by suturing the intermediate crura together and putting in a columellar strut made of septal cartilage between the medial crura. Further tip shaping and projection can be obtained with suture techniques of the lateral crura and domes. If this is not sufficient, a cartilage graft can be sutured to project above the domes and give a little more projection. If the tip is not supported pre-emptively, the forces of wound contraction tend to pull it down over time.

In primary rhinoplasty almost all surgeons these days would recommend using cartilage from your septum to strengthen the nose and prevent the tip drooping/nasal collapse over time. The alternatives to your "own cartilage" are artificial materials like goretex or silicone, which both run the risk of being rejected by your body which can be a disaster seeing as your nose is right in the middle of your face. Lastly, there is cadaver rib cartilage that can be used, but some studies suggest this resorbs over time which risks your nose changing too much over the years. Best of luck!

The use of your own cartilage in rhinoplasty is preferred when possible because of the bio-compatibility of using your own tissue. Septal cartilage from a septoplasty is one of the most common sources of cartilage for a rhinoplasty but other common sources are the ears and ribs. Septal cartilage usually provides finer and straighter pieces of cartilage to work with while the ears and ribs tend to provide heavier and curvier pieces of cartilage. The different donor sites also have different side effects for the donor sites which have to be taken into consideration. For further information I would encourage you to ask your surgeon to explain what he or she plans to do with the cartilage and where they plan to harvest it from.

The best cartilage to use for rhinoplasty is the nasal septal cartilage. The surgeon does not have to make an extra incision in order to harvest this cartilage and it has the best qualities for grafting. The second source of cartilage is from the ear and the incision is minimal. The third source of cartilage is from the rib and this is the most visible incision with the most postoperative pain. The rib graft is typically used in complex secondary rhinoplasties. In a primary rhinoplasty where a septoplasty has not been performed I always prefer harvesting the nasal septal cartilage. On every patient I perform cartilage grafting for two reasons. First for cosmetic refinement of the nasal dorsum referred to as the dorsal aesthetic lines and for cosmetic refinement of the nasal tip. Second for structural support of the nasal dorsum and the nasal tip to improve the nasal airway and prevent postoperative deformities. Cartilage grafting is an essential component of any rhinoplasty. Furthermore, harvesting temporalis fascia can be quite helpful in certain circumstances. I think it is important to use the patients own tissue grafts and avoid synthetic grafts and or grafts harvested from non-human sources. In my personal opinion silicone grafting in the nose is prohibited. Additionally, in certain cases Restylane can be used postoperatively to correct minor imperfections. Best of luck in your endeavors.

It all depends really. Usually, the septal cartilage works well for a lot of things in the nosee, although the ear and the rib have been used. Ciontrolling the tip is often the hardest part of any rhinoplasty, and the fact is, good judgement and technique (ie doing the best procedure for your nose without getting too "fancy") is what minimizes the need for revision.

Septal cartilage is best for the tip to give it support and avoid droop over the long term