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Page 4 of 7 Apaydin. Plast Aesthet Res 2019;6:9 I http://dx.doi.org/10.20517/2347-9264.2018.73

A B

C D E

Figure 4. Two splinting spreader grafts are sutured to the small piece of septal cartilage at the key area (A); a new septum is constructed
by bringing two 2 mm thick implants sutured to each other by 0.5 mm thick graft (B, C); the new septum is sutured to the spreader grafts
to rebuild the L-strut (D); the medial crura are sutured to the new septum as a tongue-in-groove (E)

A B

C D E

Figure 5. The sixth rib harvested with rectus abdominis fascia and the outer perichondrium (A); multiple implants of various thicknesses
are cut by oblique split (B); two laminas are sutured together for augmentation (C); the dorsal surface and the lateral parts of the implants
are covered by perichondrium for camouflage (D, E)

Saddle nose
In saddle noses, there are two main issues to address: the nasal septum and the need for augmentation.
Regarding the septum, the technics are described above. For dorsal augmentation, I have been using the
[7,8]
following techniques: (1) Solid onlay grafting; (2) Laminated grafts; (3) Diced cartilage in fascia ; (4)
Cartilage chips in fascia.

The Laminated graft technique involves the combining of two or more obliquely cut grafts by suturing. They
are tailored to the needs of the augmentation by partial shaving. I like covering the upper part by means of
perichondrium obtained from the outer surface of the rib [Figure 5]. The advantage of this technique is that
many oblique cut grafts can be brought together to get the desired dimensions with no risk of warping and
resorption.