Optimizing the Septal Donor Site in Asian Rhinoplasty: A Computed Tomography-Based Simulation of the Bony-Cartilaginous Unit and Skull Base Safety.

backgroundAsian rhinoplasty frequently requires robust structural support to counteract a thick skin envelope. However, relying solely on septal cartilage often leads to graft depletion after preserving a safety L-strut. This study quantifies the volumetric sufficiency of the composite bony-cartilaginous unit to address this limitation while ensuring skull base safety.

methodsA retrospective computed tomography analysis was performed on 116 Asian adults (60 men, 56 women). A standardized harvest template was virtually executed, assuming the preservation of a 10-mm L-strut. Total septal area, harvestable cartilage, and the composite bony-cartilaginous unit (cartilage, perpendicular plate of the ethmoid, and vomer) were quantified using defined anatomical landmarks.

resultsThe harvestable septal cartilage averaged 461.5 mm

conclusionsSeptal cartilage is an inherently scarce resource in Asian rhinoplasty, particularly in females. Harvesting the septum as a bony-cartilaginous unit safely and reliably doubles the graft supply. With precise osteotomy trajectories, this composite graft eliminates the need for distant donor site morbidity, serving as an optimal local reserve. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .