Rhinoplasty in the graft-depleted patient

As more surgeons become familiar with varying autogenous donor sites, a group of secondary rhinoplasty patients is emerging with donor-site depletion, having already had septoplasty or harvesting of one or more auricular, calvarial, iliac, or rib grafts. Even the primary patient may be donor-site depleted if the septum is bony and yields minimal usable cartilage. This article outlines some principles for achieving acceptable functional and aesthetic results with suboptimal or minimal graft material.