In the filed of rhinoplasty, there are so many materials for graft purposes. I have my special technique to smoothen the dorsum and radix after cartilage graft. Mastoid periosteum is a relatively thick periosteum behind the ears. It affords soft covering on the irregular dorsum with slight volume. I use this graft especially for radix augmentation. It makes the forehead to nose transition smooth and natural. Harvesting scar is well camouflaged within the postauricular skin crease and there is no complication.
This lady in below photos had nasal deviation, hump nose, and tip ptosis with breathing difficulty. Septum was corrected first, and this made the lower 2/3 of the nose straight. Hump was not resected but rasped with Piezotome and this did not breach the keystone area, which made spreader grafts unnecessary.Bilateral osteotomies with Piezotome made her bone straight. Together with septum correction and effective osteotomies, her nose became straight from the frontal view. Tip was modified with sutures and onlay graft only. No strut or septal extension graft was used and this made the tip soft even after considerable amount of rotation and projection increase. Radix was augmented with bruised cartilage. Overall, she could breath much better after surgery and her nose became more harmonious and feminine.
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