Cartilage grafting is a common procedure used to provide additional structural support to the nose during rhinoplasty procedures. There are several types of cartilage grafts that may be used during this type of operation, each with its own benefits and risks. Costal cartilage, taken from the ribs, is one of the most common types of cartilage grafts used during rhinoplasty. Rib grafts made from abdominal fat pads are also commonly used for this purpose, as there are many types of cartilage that exist in these fatty tissue deposits throughout the body.

In this guide, we review the aspects of Cartilage Graft Rhinoplasty, how long do cartilage grafts take to heal, ear cartilage rhinoplasty pros and cons, and cartilage graft nasal septum.

Cartilage Graft Rhinoplasty

Rhinoplasty is a cosmetic procedure that involves modifying the nose to improve its shape and appearance. During rhinoplasty, cartilage grafts may be used to support a depressed nasal bridge or provide additional height in cases where there isn’t enough septal cartilage available for use during the procedure. Depending on your particular needs, different types of cartilage grafts may be used during this type of surgery including costal cartilage taken from ribs or rib grafts made from abdominal fat pads.

Rhinoplasty begins with the patient and surgeon discussing their aesthetic goals and expectations.

Before you can get started with your rhinoplasty procedure, it’s important to have a discussion with your surgeon about what you want and how they will achieve it. This step is crucial for two reasons: firstly, because it allows both parties to understand each other’s expectations; secondly, because this conversation will help determine what type of surgical approach is best for achieving those goals.

Your surgeon will take into account many factors when determining whether or not cartilage grafting is necessary–for example, if you have severe scarring or deformities from previous injuries or surgeries on the nose that require repair before narrowing can be done safely without causing further damage. Your surgeon may also recommend using cartilage grafts if there are any irregularities in their shape (such as bumps) that cannot be corrected through traditional techniques alone

The surgery is performed under general anesthesia.

The surgery is performed under general anesthesia. Anesthesia is administered by a medical professional, who may also be your doctor or nurse. The patient will be asleep and unaware of the procedure, so they will not feel any pain during it. They can wake up when they are ready to leave after their recovery period following surgery has ended.

The cartilage graft rhinoplasty procedure involves removing part of your nose’s cartilage layer (periosteum) to create a new space for new bone growth within that area of your face where there was no cartilage before. It helps restore balance in structure and appearance while improving breathing patterns through opening up blocked passages within the nose.”

The incisions are placed inside the nostrils or in the crease that connects the nose to the upper lip.

The incisions are placed inside the nostrils or in the crease that connects the nose to the upper lip. The surgeon will use these incisions to remove cartilage from your septum, which is a bone that divides each nostril from side-to-side.

A small, flexible tube attached to a camera will be placed through one of the incisions to help guide the surgeon. This allows for greater accuracy when sculpting the cartilage grafts into place.

The small, flexible tube attached to a camera will be placed through one of the incisions to help guide the surgeon. This allows for greater accuracy when sculpting the cartilage grafts into place.

The new shape is held in place with sutures or metal screws.

The new shape is held in place with sutures or metal screws. Sutures are made of dissolvable material, so they can be removed over time. Metal screws also hold your new nose in place, but they are not removed. Instead, they dissolve over time and leave no trace behind.

The surgeon then uses dissolvable sutures to close any incisions before applying dressings and tape to protect the nose. Section: Cartilage may be taken from other parts of the body to provide a natural-looking result if adequate septal cartilage cannot be found.

After your surgeon has completed the procedure, he or she will use dissolvable sutures to close any incisions before applying dressings and tape to protect the nose. Cartilage may be taken from other parts of the body to provide a natural-looking result if adequate septal cartilage cannot be found.

Cartilage grafts can be used to correct a wide range of defects, including:

• A deviated septum that causes difficulty breathing through one side of the nose ( called nasal obstruction)
• A crooked nose due to injury or birth defect
• The collapse of part of the nose following an accident involving facial trauma

This procedure can take anywhere from one to four hours depending on the extent of correction that needs to be performed.

Rhinoplasty is a surgical procedure that reshapes the nose and improves its appearance. During rhinoplasty, a surgeon will trim away excess cartilage, bone and skin to refine the shape of your nose. Depending on your goals for surgery, they may also make minor adjustments to other parts of your face such as your eyes or cheeks.

Rhinoplasty can take anywhere from one hour up to four hours depending on how much correction needs to be performed overall. The length of time depends in part on whether general anesthesia or local anesthesia is used during surgery (local anesthesia only numbs small areas around incisions). This choice should be made based on patient preference and comfort level with being awake during surgery; it does not affect recovery time afterwards nor does it affect final results in any way whatsoever!

In general terms:

• A full rhinoplasty takes about 3 hours under general anesthesia with intraoperative splints applied immediately after completion so that swelling doesn’t occur overnight before being removed early next morning by nursing staff upon waking up post op day 1).
• A partial rhinoplasty takes about 1 hour under local infiltration/intravenous sedation/conscious sedation (meaning patient remains conscious throughout entire procedure but feels little pain).

Your cosmetic surgeon will outline your surgical plan at your initial consultation and there’s no need to have all the details memorized by surgery day.

Your cosmetic surgeon will outline your surgical plan at your initial consultation and there’s no need to have all the details memorized by surgery day.

The doctor will go over the procedure with you before surgery, explain what can be expected during recovery and answer any questions you have about the procedure. It’s important to ask questions so that you understand what is involved both during and after your rhinoplasty.

how long do cartilage grafts take to heal

Rhinoplasty is a complex procedure, whether it is performed for the first time or as a revision procedure. In many cases, a graft is used to create stability and balance in the new nose shape. Using the patient’s own cartilage, either from the nose itself or a donor site, tends to provide the most natural, long-lasting results. One of the donor sites that is frequently considered and used by Dr Roth is a rib graft.

Reasons for a Rib Graft The first choice in cartilage grafts for a rhinoplasty procedure is usually the septum. The septum is the straight cartilage inside the nose that separates the two nasal passages. This cartilage tends to provide the best rhinoplasty results because of its strength and size. However, septal cartilage may not be available for grafting, often due to previous nose surgery. In that case, Dr Roth will look at harvesting cartilage from the ear or rib for the procedure.

Choosing a Rib Graft Rib cartilage is often preferable over ear cartilage because it tends to be stronger and more plentiful. Dr Roth commonly removes the cartilage from the fifth or sixth rib, since this area makes it easy to hide the small incision inside the crease of the breast or chest muscle. The fifth rib is usually straighter but smaller, while the sixth rib offers more cartilage but with additional curvature. Dr Roth will choose the donor rib based on the amount of cartilage he needs and how he will use it in your rhinoplasty procedure.

The Rib Graft Procedure The removal of the rib graft may be performed on an outpatient basis, but many patients will spend the night in a hospital or surgical centre after the procedure to allow the healing process to begin. General anaesthesia is always used for this surgery. Rhinoplasty is usually performed at the same time as the rib graft, and the entire procedure may take up to four hours to complete.

After the procedure, patients will need time to recover from both the rhinoplasty and the rib graft. Most are able to get back to light activities within two weeks and a full schedule within 4-6 weeks. It will take time to see the full results of the rhinoplasty, as bruising and swelling will need time to subside before you will start to see how your new nose will look.

When choosing rhinoplasty with a rib graft, it is very important to choose a surgeon experienced in this specific technique. Rib cartilage may be challenging to work with and it takes a degree of skill to use the graft material to create a natural look. Dr Roth has ample experience with rhinoplasty procedures, including those using rib grafts. To learn more about this surgery, contact Dr Roth’s office at 02 9982 3439.

ear cartilage rhinoplasty pros and cons

Augmentation rhinoplasty is one of the most common plastic surgeries performed, and rightly so. There is a wide variety of reasons you might have for looking into this and they range from difficulty breathing, improving self-confidence or simply to change the appearance of your nose. Whatever the reason may be, we want to help you understand the difference between a silicone implant and an autologous (cartilage) rhinoplasty before your official consultation with a plastic surgeon.

Before we explore the differences between these two procedures, we want to share that augmentation rhinoplasty is not just about implants and adding something to your nose. It can also involve reshaping as well as removal. Here are some common reasons where this can happen in augmentation rhinoplasty.

Top Reasons for Augmentation Rhinoplasty

Hump Nose

Having a hump nose is completely normal but if you have had one all your life and would like to get it addressed, the procedure during augmentation rhinoplasty would involve smoothing out the cartilage on the bridge of the nose. 

Crooked Nose or Deviated Septum

It is estimated that about 80% of people have a deviated septum or crooked nose. When fixing a crooked nose, the procedure can allow for a symmetrical appearance as well as to repair a deviated septum through septorhinoplasty.

Under or Overly Projected Nose

Overly projected or overly wide nose bridges can cause noses to look too large for the size of a face while an under projected nose can cause noses to, conversely, look too small for a face. This can also be addressed through a reduction or augmentation rhinoplasty, respectively.

Bulbous or Misshapen Nose Tip

A bulbous or misshapen nose tip can really affect the appearance of someone’s face. This is one of the toughest things to address about the nose as it involves multiple tissue types – the nose tip skin, the fatty layer below, as well as the cartilages of the tip (lower lateral cartilages). Procedures to reshape the tip often entail the reshaping of the tip cartilages as well as the addition of cartilage grafts. The fatty tissue of the tip may also need to be carefully trimmed, as over removal can cause the skin of the nose tip to turn black (necrosis).

Large Nostrils

Lastly, even overly large nostrils can be reduced during surgery if you should wish it so. This is performed with a simple alar reduction that involves the removal of a crescent-shaped piece of tissue at the base of the nostrils.

Silicone Implants

Silicone implants are a reliable type of implant that has been used for many years and improved upon multiple times. The silicone implants we see today can be shaped precisely into what is needed for each individual patient. This allows for customisation towards your face and to suit your own particular needs. In addition to these anatomical implants, soft silicone implants are used in lieu of the hard stiff silicone that traditional implants were carved from, resulting in a much more natural appearance and feel. Having multiple honest consultations with a plastic surgeon will help them to precisely carve out what is needed for you during this journey.

These implants come in two common shapes: L-shape and I-shape. However, at Allure, we use only the I-shape implant as the L-shape implant has a much higher rate of extrusion. The L component of the implant is replaced with cartilage grafts to create the tip projection and definition, resulting in a much more natural appearance with a reduction in implant extrusion rates.

Silicone implants are popular because they can be easily removed or replaced in the case of malposition, infection or protrusion. 

Pros of Silicone Implants:

Cons of Silicone Implants:

However, every type of material has its pros and cons. With the right amount of check-ups, some things can be avoided after a successful surgery. 

Gore-tex implants were very popular at one stage, due to the high rate of tissue integration, which meant that they were less likely to migrate or get displaced. However, many surgeons realised that because of this extensive tissue integration, it was extremely difficult to revise a Gore-tex implant rhinoplasty if there were problems, often needing to remove a huge amount of nasal tissue around the implant in an en-bloc fashion, resulting in a long recovery time and poorer outcomes.

Autologous (Cartilage) Rhinoplasty

Autologous (Cartilage) rhinoplasty is created from a patient’s own body and is considered one of the top choices during Rhinoplasty. Far from being a dangerous practice, it is almost always necessary to harvest some amount of cartilage during surgery. Due to rumours and misinformation spread on the internet, cartilage rhinoplasty has been seen as an unattractive procedure for a long time but during proper consultations, plastic surgeons will always tell you that the misinformation you have heard is not accurate.

Through manipulation of existing nasal cartilage as well as the use of the nasal septal cartilage, autologous rhinoplasty can address multiple issues such as an under-projected tip, a short nose, droopy nasal tips and so on. However, if there isn’t enough nasal cartilage tissue in a patient’s nose, surgeons will then use cartilage grafts from other areas to rebuild the nose.

Some areas in the body that exist as donor sites for external cartilage are the ear (conchal) or the rib (costal). But if these areas are not available during surgery for grafting, or if the patient elects to not use these sites, donated sterilised cadaveric rib cartilage can also be purchased and used as a source for cartilage grafts.

Pros of Cartilage Rhinoplasty:

Cons of Cartilage Rhinoplasty:

However, with these pros and cons laid out for both types of implants, it is important for us to clarify that many of these “cons” can be avoided if the plastic surgeon is experienced and carries out a surgery well. Something that you should always look into when exploring different clinics and surgeons is each surgeon’s track record.

In addition to cartilage, dermofat grafts are also used to augment the shape of the bridge, though less commonly. These grafts are harvested from the midline cleft between the buttock cheeks, resulting in a well-hidden scar and minimal donor issues. This dermofat graft is then trimmed into an implant-like shape before being inserted into the nose just like a silicone or cartilage implant. The advantage of using this graft is a much softer and very natural appearance of the bridge after the surgery. The disadvantage is a longer period of swelling as the graft slowly integrates as well as it does not allow for very high augmentations of the bridge.

The nose is a prominent part of our face and identity. When choosing a plastic surgeon, we highly recommend you to consult with as many as you can and to take into account the surgeon’s knowledge of the different types of noses that each ethnicity can have. The way all our noses are built is very different and these differences can be even wider between the different races.

When consulting with various plastic surgeons, always make sure that the conversation is open and honest during your journey. Not just because it is essential to know who will be operating on you but to also know the practices of the clinic, track records as well as exploring what you are trying to get out of the surgery. It is important to be as precise and open as possible with what you’re hoping to get rid of or to modify, what issues you currently have whether it is cosmetic or health-related as well as what you’re comfortable with. It is a journey that you will be embarking on and it is important that you feel safe during the process. 

Lastly, do your own preparations before a consultation by gathering your medical history and to write down some questions you might have for your doctor. During your meeting, you will be asked to go for a physical examination, go through your medical history as well as have your nose photographed such that your surgeon can manipulate the photos to show you what kind of results are possible. We hope that this article helps you prepare for an augmentation rhinoplasty consultation with your doctor.

cartilage graft nasal septum

The Role of Septal Cartilage in Rhinoplasty: Cadaveric Analysis and Assessment of Graft Selection

Background: In addition to providing nearly 50% of total airway resistance via the internal valve, the nasal septum provides support for the cartilaginous portion of the nasal dorsum, and it is responsible for determining the projection of the nasal tip. In modern rhinoplasty, septal cartilage plays an important role as a donor graft material.

Objectives: The authors evaluate the anatomy of nasal septal cartilage, identifying variations according to certain regions of the septum and proposing a correlation between the topography and morphology of septal cartilage and graft choice.

Methods: An anatomical study was performed on 14 fresh adult cadavers. The excised septal cartilage was placed on grid paper; digital images were taken; all septal cartilage was divided into nine equivalent quadrants; and quantitative measurements for length, height, and area were calculated and compared. Statistical significance was set at P < .05.

Results: The average length of the septum was 35.14 mm, while the average height was 32.5 mm. The average septal area was 933.11 mm2. The septal thickness mean values were analyzed in nine quadrants, ranging from 1.04 to 1.71 mm. Statistically-significant differences in mean values were found in 13 of the 14 cadavers. Specifically, the central and cranial areas were thickest, and the area corresponding to the L-strut was thinnest.

Conclusions: Anatomical variations of the thickness of septal cartilage excisions were found to be statistically significant, and these differences play an important role in the proper selection of the septal grafts.

The importance of nasal septal anatomy is related to the central support provided by this structure and its articulation with the upper lateral cartilage. This framework forms the internal valve, which is responsible for almost 50% of total airway resistance.1-3 Cephalometric studies have also demonstrated the importance of the septum in the middle third of facial and nasal development.4 In modern rhinoplasty and nasal reconstruction, septal cartilage plays another important role—that of a donor graft material.5-10 The nasal septum provides support for the cartilaginous portion of the nasal dorsum and tip; it is also important in determining projection of the nasal tip.1-3,11 In an effort to strengthen the osseocartilaginous framework, thereby reducing the effects of unpredictable scarring, surgeons are routinely performing conservative reductions and frequently utilizing grafts during rhinoplasty.12,13

The variety of grafts available for reconstruction of the nasal dorsum, for support of the internal and external valves, and for projection/definition of the nasal tip has led to a need for more cartilage donor sites. The septum is the primary nasal graft donor site and the first choice of most authors.7,9,12 Features that make it especially useful include the surgeon’s ability to harvest the graft from the same operative site, a low rate of infection and absorption, and a ready supply of straight, strong cartilage in moderate amounts. When the necessary graft is larger than the available septal material—and in cases of secondary rhinoplasty, where the septum has already been tapped—costal cartilage and ear cartilage are alternatives.

The proper selection of donor grafts has a major impact on long-term results; proper thickness, sufficient length, and a low possibility of distortion (mainly in the costal cartilage) are essential features of the ideal graft.5,12 Although we know that the nasal septum provides strong and straight cartilage, few studies have assessed the appropriate thickness, length, and area of such cartilage to determine the ideal material and site for each type of nasal graft.

The purpose of this study was to evaluate the anatomy of nasal septal cartilage through precise measurements of height, length, area, and thickness in a cadaver series, identifying variations according to certain regions of the septum. Additionally, we propose a correlation between the topography and morphology of septal cartilage and graft choice.

Methods

An anatomical study was performed on 14 fresh adult cadavers, 12 male and two female, with apparent ages ranging between 20 and 70 years. Although the medical histories were unavailable, any specimens with physical signs of facial trauma, nasal abnormality, or prior nasal surgery were excluded.

In each cadaver, an open-approach rhinoplasty was carried out, including step-by-step dissection with submucosal release of the upper and lower lateral cartilage connections and release of the osseocartilaginous adhesions (Figure 1). Septal cartilage dissection then proceeded in a subperichondrial surface, and the cartilage was removed in its entirety. When the bony structures accompanying the septal cartilage were reached, which ensured complete removal, they were carefully separated from the cartilage before measurements were taken. The excised septal cartilage was placed on grid paper; digital images were captured; and measurements of specific areas were made with ImageJ 1.42q software (National Institutes of Health, Bethesda, Maryland; software is open-source). The total area was calculated, along with the points of greatest length and height (measured with a millimeter ruler).

Nasal anatomy in a fresh cadaver. The retractor exposes the septal cartilage after dissection.

All septal cartilage was divided into nine equivalent quadrants by drawing two straight lines parallel to the nasal dorsum and two lines perpendicular to those markings. These quadrants were identified as A through I (Figure 2). A posterior division in septal zones was performed to determine the new anthropometric measurements. The thickness was measured at the midpoint of each quadrant (Figure 3) with a Starrett 799 digital caliper (LS Starret Company, Suzhou, China). This caliper has a resolution of 0.01 mm, and its accuracy provided an acceptably-low margin of error in the measurements.

Excised septal cartilage is divided into nine equivalent quadrants. A posterior division in eight zones was proposed: dorsal septum = ABC, caudal septum = ADG, septal base = GHI, septal base remaining = HI, central remaining = EF, anterior to ethmoid = CFI, posterior to caudal septum = BEH, central = DEF.

Cartilage thickness measured with a digital caliper.

We also performed a computer reconstruction of the average septal cartilage area, excluding the L-strut (10 mm); this was the remaining area available for graft harvesting. Analysis was performed with descriptive and inferential statistics, according to the nonparametric Kruskal-Wallis test and a subsequent Student-Newman-Keuls test (when applicable). Results were tabulated with BioStat 5.0 software (Microsoft Corp., Redmond, Washington). Statistical significance was assumed at P < .05.

Results

The average length of the septum in the 14 cadavers studied was 35.14 mm (range, 24 to 50 mm), while the average height was 32.5 mm (range, 28 to 39 mm). The average septal area was 933.11 mm2 (range, 594.44 to 1431.87 mm2) (Table 1). Mean septal thickness was measured in nine quadrants and ranged from 1.04 to 1.71 mm; the mean thicknesses were found to have statistically-significant differences in 13 cases (Tables 2 and 3). There were no statistically-significant differences (P = .2205) when only septal zones were analyzed (Table 4). Through computer reconstruction, we determined that the average remaining septal area (after exclusion of the L-strut) was 518.66 mm2 and that the grafts could reach average lengths of 30 mm when constructed obliquely (Figure 4).

Anthropometric Measurement of Septal Cartilages

Coefficients of Variation for Cartilage Thickness Between QuadrantsAQ (from me regarding “mean differences”): is this the correct title for this column? it’s not entirely clear what these numbers represent

(A) A digital reconstruction shows the mean area of septal cartilage (red). (B) In this study, the mean area of the septal cartilage dissected was 933.11 mm.2 (C) The average septal remaining area (518.66 mm2) and the L-strut (10 mm).

Discussion

Nasal anatomy receives a great deal of attention in rhinoplasty literature.1,3,6,14-16 The intricate anatomy of the nose and its relationship to nasal support, respiratory function, and facial development have been well established.1-4,17 The placement of autogenous septal cartilage in rhinoplasty and complex nasal reconstruction has also been extensively discussed.6-9,12,13 However, studies regarding septal morphology and its relation to cartilage graft choice are rare.

Classically, it is estimated that a strut of L-shaped cartilaginous septum ranging between 8 and 10 mm, with its connections with the vomer and ethmoid bone intact, is sufficient to maintain nasal support.2,6 (Failure to place a sufficient graft may result in a saddle nose deformity.) The remaining septal cartilage harvested during L-strut excision can be useful as a donor site for many other kinds of cartilaginous grafts.5,12 Miles et al16 determined that the cartilaginous portion of the septum accounted for 47.5% of the total area of the nasal septum. Hwang et al14 evaluated septal cartilage thickness in 14 adult Korean cadavers and found that the septal base (anterior to the vomer) was the thickest area (range, 2.19 to 3.03 mm), while the thinnest was the area superior to the septal base (range, 0.74 to 0.97 mm). The mean septal cartilage height was 2.99 cm, and the mean length was 3.31 cm. In another study, Mowlavi et al6 examined 11 cadavers and identified the septal base as the thickest area (2.7 mm), the dorsal septum as having intermediate thickness (2.0 mm), and the central portion and the septal angle as the thinnest areas (1.3 and 1.2 mm, respectively). In their study, the authors suggested preserving a more generous L-shaped strut in the caudal septum.

Our study defined the central remaining zone as the thickest (Zone EF, 1.59 mm; Figure 2), with the central zone itself (Zone E, 1.42 mm; Figure 2) being the second thickest. The dorsal septum (1.11 mm) and the caudal septum (1.13 mm) were the thinnest areas. One possible explanation for this discrepancy between our results and those of previous studies is potentially more diversity in our cadaver population or even a different method of analysis. Furthermore, finding an ideal cadaver sample is difficult, given the disproportion between male and female specimens at our institute (as reflected in this study population). Since most patients who seek rhinoplasty are women, one could consider this inverse relationship a limitation of our study.

Data from this study suggest that the thinner portions of septal cartilage are precisely the areas that make up the L-strut, which is in line with the report from Mowlavi et al.6 Knowledge of these anatomical characteristics in the cartilaginous septum will allow the surgeon to more effectively plan rhinoplasty procedures in advance, since there will be a need for longer grafts in many cases (eg, extended spreader grafts, lateral crural strut grafts, and dorsal grafts).7-9,12 This knowledge may also have implications when multiple grafting procedures are planned, as nasal reconstructions requiring more than the estimated amount of septal cartilage will demand harvests from separate donor sites (eg, the ear and rib). Gunter et al8,17 emphasized that lateral crural strut grafts are effective only when they are approximately 3 cm in length and when they have an appropriate thickness to enable support of the lower lateral cartilage.

Given our measurements, we determined a suggested algorithm for utilizing specific zones of the nasal septum for certain applications. The central remaining zone (Zone EF; Figure 2) shows features that fulfill the demands of lateral crural strut grafts. However, such grafts may need to be harvested in an oblique fashion to achieve proper length. Spreader grafts have many applications, and thickness variations may allow surgeons to plan asymmetric grafts for the correction of septal deviation.9,13,18-23 The septal base remaining area (Zone HI; Figure 2) may be utilized when spreader grafts are being placed to maintain or design brow-tip aesthetic lines. Alternatively, surgeons should select thicker spreader grafts harvested from the central remaining zone for patients with a pinched or asymmetric middle nasal vault. Columellar struts must be harvested from the central remaining area to provide strong support to the nasal tip, whereas tip grafts should be harvested on the basis of the patient’s anatomical demand for thicker versus thinner and smoother grafts. Zone I seems suitable for harvesting alar contour grafts. In non-Caucasian patients, the central remaining zone should be preserved; in this way, the necessity for rib grafting is avoided for mild dorsal augmentations, since the fabrication of a double-layered septal dorsal graft from the central area (which includes the central remaining area and the central zone) could achieve 3 mm in height by itself. A portion of the ethmoid bone (attached with the remaining septal area) can also be utilized as a batten graft or dorsal graft when the available amount of septal cartilage is overestimated preoperatively.

Conclusions

When divided into nine equal quadrants, cadaveric septal cartilage dissections were shown to have areas of varying thickness throughout. The central and cranial areas were thickest, while the area corresponding to the L-strut was the thinnest zone. These anatomical variations in thickness were statistically significant between quadrants in 13 cases. Prior knowledge of these measurements will allow the surgeon to better select the septal area most suitable for manufacturing the desired graft during rhinoplasty.