Grafting in Rhinoplasty: A Survey of Surgeon Preferences When Donor Material Is Limited

Background: Achieving functional results in nasal reconstruction necessitates a focus on structural integrity. Surgeons are often challenged by limited supply of donor material for grafting. This study aims to determine the types and materials of grafts that surgeons prioritize when donor material is scarce. Methods: A survey was distributed to members of The Rhinoplasty Society. Respondents were asked to prioritize different donor materials (alloplastic material, septal, costal, conchal, and cadaveric cartilages) for common grafts (alar batten, anterior septal extension, columellar strut, dorsal onlay, lateral crural strut, radix, spreader, subdomal, tip onlay, and umbrella grafts). Results: Forty-seven surveys were completed. Septal extension grafts were the first priority for construction if given limited septal, costal, fresh frozen cadaveric, or irradiated cadaveric cartilage. Tip onlay and dorsal onlay grafts were prioritized if only limited conchal or alloplastic materials were available, respectively. The authors observed a general algorithm for choosing donor materials across graft types, with septal cartilage being the most preferred source, followed by costal, fresh frozen rib, conchal, irradiated cadaveric, and alloplastic materials. Deviances from this pattern were observed based on graft types—namely, lateral crural strut and onlay, and alar batten. Conclusions: When septal cartilage is unavailable, costal and fresh frozen cadaveric cartilage are favored for grafts that provide structural support, whereas conchal cartilage is preferred for grafts that provide contour. The data in this study may be useful in guiding the early rhinoplasty surgeon in the United States in choosing appropriate graft types and materials.