Grafting in rhinoplasty.

Advances in grafting techniques have provided the basis for a paradigm shift in rhinoplasty in which purely reductive techniques have been largely supplanted by structurally sound framework surgery. Proficiency with autologous cartilage grafting allows the rhinoplasty surgeon to achieve superior nasal definition and durable aesthetic outcomes by building a stable nasal framework that resists the contractile forces of healing responsible for delayed nasal airway compromise and aesthetic distortion. Cartilage grafts may be used to reposition, augment, or reconstitute nasal structure after cartilaginous resection and recontouring. The authors present various grafting techniques that are reliably used to sculpt the nasal framework in rhinoplasty, with emphasis on the relevant anatomy, nomenclature, and clinical indications for each approach. Judicious use of these methods results in predictable rhinoplasty outcomes with enhanced aesthetics and function.