Reconstruction of the nasal cap with a thin septal graft

Following hump resection, dorsal irregularities are common. Patients with thin skin or those whose skin will become thin will develop the stigmata of rhinoplasty due to an open roof, irregular osseous cartilaginous junction, or twisted septum becoming visible. Although other techniques have been described to overcome this problem, they have significant drawbacks. We describe a technique for dorsal camouflage using a thin septal graft. The technique has the advantages of providing dependable camouflage with autogenous tissue without raising the dorsum and without the need for a separate donor site. It involves sanding a 35 x 7 mm shield-shaped dorsal graft to less than 3/4-mm thickness and placing this over the nasal dorsum to simulate the preoperative fused dorsal cap. We have performed this technique in 18 patients followed for 28 months. We utilize this graft in all patients with twisted noses and all thin-skinned individuals. It is not a technique of dorsal augmentation but rather of camouflage.