Septal Cartilage, Rib Cartilage, Dermis: Choosing Among Three Autologous Materials

What septal cartilage, rib cartilage and dermis are each structurally good at, how much of each is available, and why the material choice follows the diagnosis.

When a nose is built from a patient's own tissue, three materials do the work: cartilage taken from the septum, cartilage taken from a rib, and dermis — the deep layer of the skin. They are not interchangeable. Each is structurally suited to a different job, each exists in a different quantity, and each behaves differently once it is in place.

This page compares the three. It is a comparison of materials against jobs, which is a narrower question than how rib cartilage surgery works as a whole — the harvest, the recovery at the donor site and what to expect from a rib-based operation are covered in Rib Cartilage Rhinoplasty. Silicone is not compared here; as a synthetic material it belongs to a separate discussion. And the situation where a revision has already consumed the septum is its own subject.

Why the material question comes last

Patients usually raise materials in the first ten minutes of a consultation, and the answer generally arrives in the last ten.

The reason is that a material is chosen to perform a specific job — hold the tip forward, extend the framework downward, raise the bridge, smooth a transition, reinforce thin skin. Until those jobs are defined, choosing a material means choosing a solution before the problem is described.

There is also a practical consequence to getting the order wrong. Each material does some things easily and others poorly, and a plan built around a preferred material tends to drift toward whatever that material handles best. The design ends up serving the material rather than the face.

So the sequence is: examine, scan, define the structural work, then select. What follows is what that selection weighs.

What “autologous” means in practice

Autologous simply means taken from your own body. That single property produces most of the differences between these three materials and a synthetic one, in both directions.

On the favourable side, autologous tissue is recognised by the body as its own. It does not carry the risks associated with a foreign material, and over time it becomes incorporated rather than merely tolerated. Where a graft is placed under thin skin, living tissue that integrates tends to behave better at the margins than something that does not.

On the other side, living tissue behaves individually. It settles, remodels and can change shape modestly as it heals — cartilage in particular has a memory of the form it held and a tendency to move toward it. Two patients given identical grafts do not always finish in identical positions. This is the reason results are assessed over months and why the follow-up schedule at Edition runs at day 1, day 5, two weeks, one month, three months and six months.

The other consequence is arithmetical. Every autologous graft has a donor site, and every donor site has a finite supply and its own recovery. A synthetic material can be ordered in any quantity; your own tissue cannot. That constraint is what makes the availability question, further down this page, a genuine part of the plan rather than a formality.

Septal cartilage

The septum is the wall dividing the two sides of the nose, and its front portion is cartilage. It is the first source considered in almost every plan, for four reasons.

It is the right kind of material. Septal cartilage is flat, straight and firm. Those three properties are exactly what structural grafts need: a strut that holds the tip forward, an extension that lengthens the framework, a spreader that opens the middle of the nose.

It is already in the operative field. No separate incision, no second donor site, no additional recovery elsewhere on the body.

It is predictable. Straight cartilage that is handled well tends to stay straight, which matters most in the grafts that carry load.

It is often being addressed anyway. Where a septal deviation is being corrected, the portion removed during that correction can frequently be used as graft material — the same operation solves two problems.

The limits are equally clear. There is not much of it: a portion has to be left in place to support the nose, and what remains available is finite. Some septa are thin, previously fractured, or so deviated that the usable part is small. And in a nose that has been operated on before, the septum may already have been harvested — which is the situation this page does not cover.

Rib cartilage

Where the septum cannot supply what the plan needs, rib is the usual source. It answers a different question: not “is there any” but “is there enough”.

What it does well. Rib supplies volume and strength in quantities the septum cannot approach. For a nose that needs substantial elevation over the length of the bridge, a long extension of the framework, or reconstruction of support that is largely absent, rib is frequently the only autologous material capable of the job.

What it costs. There is a separate donor site. At Edition the rib incision is around 2 cm, and stitches are removed at 14 days where ear cartilage or autologous rib cartilage has been used. Recovery therefore involves a second area, and the operation takes longer — total operating time at the clinic ranges from 1.5 to 3.5 hours depending on what the plan includes.

What has to be managed. Rib cartilage can warp as it settles. This is a known property of the material rather than a complication, and it is addressed through how the graft is carved, which part of the rib is used, and how the piece is oriented and fixed. It is one of the reasons rib work is planned rather than improvised.

Rib is not a second-best material. It is a different one, chosen when the requirement is volume and strength rather than a small precise strut. The wider picture — how the harvest is done, what donor-site recovery involves, what to expect over the following months — is covered in the dedicated page linked above.

Dermis

Dermis is the odd member of the three, and the most frequently misunderstood, because patients hear “graft” and assume it does the same kind of work.

It does not. Dermis is soft tissue, not a structural material. It has no capacity to hold a tip forward, extend a framework or raise a bridge against load. What it does is cover, cushion and smooth.

Its uses follow from that:

• Reinforcing thin skin. Where the covering over the bridge or the tip is thin, dermis adds a layer between the structure and the skin, so that edges and transitions underneath are less visible.
• Smoothing a contour. A small irregularity or a visible junction can be softened by a dermal layer placed over it.
• Padding over a graft. Cartilage has edges; dermis blunts them.

Dermis is harvested from a site chosen so that the resulting scar is concealed, and like any donor site it has its own healing to account for. Because the graft is soft tissue rather than cartilage, it also settles differently: some reduction in bulk over the first months is expected, which is factored into how much is placed.

Where dermis earns its place most clearly is over thin skin. The problem there is not a shortage of structure but the visibility of it — every edge, every junction, every small asymmetry transmits. A dermal layer between the structure and the skin changes what the skin has to conceal, and it does so without adding the height or the rigidity that another cartilage graft would.

The distinction matters in consultations because “we will use your own dermis” can sound like a structural solution when it is a finishing one. A plan that relies on dermis to do a support job will not hold, and the honest description of dermis is a reinforcement material rather than a support material.

The three side by side

How much is available, and what that limits

Quantity is the practical constraint that shapes most plans, and it is established before surgery rather than during it.

The 3D CT scan shows the extent of the septum and its condition along its whole length, including the deeper portion that cannot be assessed by looking. That measurement decides whether the septum alone can supply the plan.

Three situations follow.

The septum is sufficient. The plan proceeds from it, with no separate donor site. This is the most common outcome in a first operation with modest structural requirements.

The septum is sufficient for part of the plan. Septal cartilage is allocated to the jobs that need precision — a tip strut, an extension — and another source supplies bulk elsewhere.

The septum cannot supply the plan. Either the requirement is too large or the septum is too thin, too deviated or too small. Rib becomes the primary source, and the patient is told this before the operation rather than discovering it afterward.

The reason for establishing this in advance is not administrative. A plan that runs short of material during surgery has to be redesigned under time pressure, without the patient in the conversation.

How the choice follows the diagnosis

Three worked examples make the principle concrete. They are illustrations of reasoning rather than descriptions of particular patients.

A well-supported bridge with a blunt, dropped tip. The work is concentrated at the tip: support, projection, definition. Septal cartilage is well suited, and the quantity required is modest. This is the pattern that most often allows an implant-free plan — the conditions for which are set out in Implant-Free Rhinoplasty.

A low bridge requiring elevation along its whole length. The requirement is volume over a span, held smoothly, under skin that will show any irregularity. The septum cannot supply that quantity. The autologous answer is rib; the alternative is a shaped implant, which is discussed in Custom-Carved Silicone.

Adequate structure under thin skin that shows every edge. The structural work may be small, and the dominant problem is transmission through the covering. Here dermis does the decisive work, layered over the structure, while cartilage handles whatever support is needed.

In each case the material is a conclusion. Reverse the order and the third example becomes a plan to “use dermis”, which describes a technique rather than a solution.

When the plan needs more than the septum holds

In a first operation this is usually a matter of quantity and is settled by turning to rib. The harder version arises in revision, where a previous surgery has already taken the septal cartilage and the tissue has changed as well.

That situation has its own assessment: what remains, what has been altered, and what the alternatives are when the most convenient source is gone. It is covered in Running Out of Graft Material.

For a first surgery, the point that matters is simpler. The material plan should be stated before the operation, with the primary source named and the fallback named, so that nothing about it is a surprise on the day.

Why the septum's yield is set by its other job

The quantity available from the septum is often discussed as though it were a matter of size — a larger septum yielding more, a smaller one less. Size matters, but it is not what sets the limit.

The septum is not a reserve of spare cartilage that happens to be located in the nose. It is a structural wall, and it does two things at once: it divides the airway into two passages, and it holds the middle of the nose up. Take too much and the nose loses the support that keeps its own profile from collapsing inward.

So harvesting from the septum is not a question of how much is there. It is a question of how much can be removed while leaving an intact supporting frame along the top and the front — a continuous band of cartilage running beneath the bridge and down toward the tip, which has to stay. What can be taken is what lies behind and below that band.

This is why two people with similar-looking noses can yield quite different amounts, and why the figure cannot be estimated from the outside. It is also why the septum is assessed on imaging before it is counted on: what matters is the shape and completeness of the frame that has to remain, not the overall dimensions of the wall it belongs to.

Questions worth asking about the material plan

Material is one of the few parts of a rhinoplasty plan that a patient can interrogate usefully without medical training, because the answers should be specific and checkable against your own scan.

“What structural jobs does my plan involve?” The answer should be a short list — support the tip, extend the framework, elevate the bridge, reinforce thin skin — not a single word such as “augmentation”.

“Which material is doing each job, and why that one?” A good answer pairs each job with a material and a reason. A vague answer usually means the plan has not been broken down that far.

“How much septal cartilage do I have?” This is measurable from the scan. If the plan depends on the septum, the quantity should have been established rather than assumed.

“What is the fallback if there is less than expected?” Every plan should have one, and you should know it before the day rather than hear about it afterward.

“Where is the donor site and what does its recovery involve?” Applies to rib and to dermis. The incision length, the stitch removal timing and what the area feels like for the first weeks are all reasonable things to know in advance.

None of these questions is adversarial. They are the questions the plan already answers internally, and asking for them out loud is the simplest way to find out whether the plan exists at that level of detail.

About the author

Dae-hee Han, MD — Board-Certified Plastic Surgeon (specialist certificate No. 2045, issued 3 March 2014; medical licence 00394, issued 26 February 2009). Master’s degree, Ajou University School of Medicine. Training at the Craniofacial Center, Chang Gung Memorial Hospital, Taiwan (2013), and the IFAAS Mini Fellowship, University of Florida, USA (2016). Three rhinoplasty papers published in SCIE-indexed international journals. More than 4,500 nose surgeries — Dr. Han’s career total from 2017 to 2025, counted from medical records. Eighteen years in practice since medical licensure in 2009; thirteen years as a board-certified plastic surgeon. He carries out consultation, surgery and follow-up personally; fee guidance is given by the clinic’s consultation manager.

Last reviewed: 2026-08-15

Clinic information

Edition Plastic Surgery Clinic & Dermatology
6F, OPUS 407, 407 Gangnam-daero, Seocho-gu, Seoul 06614, Republic of Korea
One minute on foot from Gangnam Station Exit 10
Tel +82-2-591-0100 · editionprs@gmail.com
Consultation hours: Monday to Friday 10:00–19:00 · Saturday 10:00–17:00 · closed Sundays and public holidays

Disclaimer

Individual results may vary. Bleeding, infection, swelling, asymmetry, and scarring can occur. Please decide after a full consultation with a board-certified specialist.

This page is general medical information. It is not a diagnosis, and it does not promise a particular outcome. Surgical fees are given after an in-person consultation.