Is there a downside to using septal cartilage alone during Asian rhinoplasty?

Septal cartilage varies in thickness and strength from patient to patient, and from ethnicity to ethnicity. Patients with large, prominent noses often have thick septal cartilage which has a lot of intrinsic strength and resilience. In performing rhinoplasty on this subset of patients, a surgeon can comfortably harvest septal cartilage while preserving ~10-15 mm of dorsal and caudal strut while still maintaining the structural integrity of the nose. When the septal anatomy does not have much thickness, strength, or quantity, as can often be the case in Asian noses, then preserving only 15 mm of septal width is not sufficient to preserve the shape of the nose. With a 15 mm dorsal or caudal strut, the cartilage may still buckle and create a saddling of the nasal dorsum, loss of projection and ptosis of the nasal tip, or an even more serious collapse of the nose. For Asian patients often 18-20 mm of septal strut should be preserved to maintain the strength of the septum.

In addition to the increased risk of weakening the structure and shape of the nose by over-resecting cartilage from the septum of an Asian nose, the question still remains whether or not the harvested septal cartilage will provide enough structure and rigidity to reshape the nose. Often the septal cartilage does not provide enough support to resist the forces of thick, sebaceous skin and will be insufficient to create adequate, durable structure. The ideal case for using septal cartilage alone remains for patients with large, thick septal cartilage and requiring only mild to moderate structural grafting in the presence of of thin to medium skin thickness.

Septal cartilage is frequently removed during septoplasty for straightening the septum. Septoplasty may be performed entirely through incisions hidden inside the nose without affecting the shape of the nose. Asian patients, however, should be mindful of the fact that this otherwise straightforward operation should be performed with proper regard of the differences between Asian nasal anatomy and the typical white nose to avoid any of the complications of over-resection of the septal cartilage.