Structural grafting in rhinoplasty.

Many surgeons consider cosmetic rhinoplasty to be one of the most challenging facial plastic surgical procedures. Open-structure rhinoplasty allows for visualization of bony-cartilaginous deformities, preservation of nasal structural integrity, and precise nasal reshaping. The ultimate, external appearance of the nose is the sum of the interaction of the bony-cartilaginous skeleton and the skin soft-tissue envelope. This article describes the use of autologous, structural cartilage grafts in primary and secondary rhinoplasty. Emphasis is placed on the use of septal, auricular, and costal cartilage grafts to provide for a structurally sound skeletal framework and thereby a predictable postoperative result. Deformities of the middle and lower third of the nose are specifically addressed.