A. To put it simply: septal damage is repaired through autologous cartilage grafting — restoring both the structural backbone of the nose and nasal airway function simultaneously.

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Here's why.

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1. The septum's critical role. The nasal septum is the midline cartilaginous and bony partition dividing the nasal cavity. It functions as the central pillar of nasal support. When over-harvested or damaged during prior surgery, the entire nasal framework loses its foundation — leading to dorsal collapse, tip ptosis, and significant airway obstruction.

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2. Reconstruction methods. If residual septal cartilage is available, it can be repositioned and reinforced. When septal cartilage is insufficient, conchal cartilage (from the ear) or autologous costal cartilage is harvested to fabricate a new septal strut. In severe cases where virtually no septum remains, costal cartilage is used to build an entirely new septal framework.

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3. The L-strut paradigm. Septal repair is not simply "filling a hole with cartilage." It requires reconstruction based on the L-strut concept — the L-shaped cartilaginous framework that provides structural support to both the dorsum and the caudal (tip) portion of the nose.

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Why the Closed Approach Makes a Difference

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Septal reconstruction is arguably the area where the closed approach excels most. The endonasal route provides direct, unimpeded access to the septum. Key advantages include:

- Mucosal flap preservation: Maintaining septal mucosal blood supply maximizes graft incorporation and healing

- Reduced septal perforation risk: Less mucosal elevation means less risk of creating or enlarging a septal perforation

- Functional preservation: Minimal mucosal trauma supports better postoperative nasal airflow

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When to Be Cautious

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- Severe septal deviation or pre-existing septal perforation significantly increases reconstruction difficulty.

- When the septum has been nearly completely resected in prior surgery, large-scale costal cartilage reconstruction is required.

- In such cases, functional recovery (airway) must take priority over aesthetic goals.

- If the residual septal cartilage is thin, weak, or severely deviated, it is unsuitable as a graft donor — alternative cartilage sources are mandatory.

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What I've Observed in Clinical Practice

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In my experience, the majority of septal damage patients recover both structural stability and airway function through appropriate cartilage grafting. L-strut reconstruction yields particularly stable long-term results. For patients with severe septal deviation, I sometimes employ extracorporeal septoplasty — removing the entire septum, reshaping it externally, and reimplanting it in the correct position.

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Surgeon's Note

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If you suspect septal damage, a CT scan is the essential first step. As a surgeon who has performed all revision and reconstructive rhinoplasty exclusively through the closed technique, I place great importance on addressing both function and structural integrity in every procedure. If you have breathing difficulties, do not delay seeking specialist evaluation.

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Summary

- Septal damage is repairable using autologous cartilage (septal, conchal, or costal) based on the L-strut framework concept

- The closed approach provides direct septal access with superior mucosal preservation and lower perforation risk

- CT imaging is the mandatory starting point for any septal reconstruction plan