title: Precision carving of costal cartilage graft for contour fill in aesthetic and reconstructive rhinoplasty.
abstract: BACKGROUND
  Autogenous costal cartilage is a good option for large volume requirements in rhinoplasty, when septal or conchal cartilages do not suffice. Reluctance to use costal cartilage is due to apprehension of warping. However, warping can be avoided if we follow the principle of balanced section as advocated by Gibson and Davis. "Warping" can also be utilized to change the curvature of the graft.
  
  
  METHODS
  We have used 69 costal cartilage grafts as a solid piece for contour fill in rhinoplasty in 31 patients over the last 10 years. Principle of balanced section as advocated by Gibson and Davis was adhered to while carving the grafts, however some grafts were allowed to warp to get different sizes and shapes.
  
  
  RESULTS
  All the procedures were uneventful. Aesthetic appearance of all patients was satisfactory and acceptable to all the patients. In two cases, the dorsal graft minimally shifted to one side, but remained straight. In one patient, there was late appearance of distortion.
  
  
  CONCLUSIONS
  The mode of cartilage warping is predictable and it can be used to advantage. Apprehension to use costal cartilage graft is unjustified, as with precision carving a desired shape can be obtained.
authors.affiliation: Department of Plastic Surgery, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India.
authors.forename: Uday
authors.initials: U
authors.lastname: Bhat
authors.affiliation: Department of Plastic Surgery, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India.
authors.forename: Sanchit
authors.initials: S
authors.lastname: Garg
authors.affiliation: Department of Plastic Surgery, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India.
authors.forename: Eulalia J
authors.initials: EJ
authors.lastname: D'Souza
authors.affiliation: Department of Plastic Surgery, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Agarkhedkar
authors.affiliation: Department of Plastic Surgery, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India.
authors.forename: Ibohal Akoijam
authors.initials: IA
authors.lastname: Singh
authors.affiliation: Department of Plastic Surgery, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India.
authors.forename: Amresh S
authors.initials: AS
authors.lastname: Baliarsing
keywords: Autogenous cartilage; balanced section; costal cartilage graft; rhinoplasty; warping