A Case of Congenital Nasal Septal Cartilage Hypoplasia Requiring Secondary Rhinoplasty in Adulthood: Considerations on Timing and Graft Selection.

Treatment of nasal septal defects or hypoplasia requires careful, long-term planning. We report a case of a 20-year-old male with congenital nasal septal cartilage hypoplasia who underwent auricular cartilage grafting at age 5 and costal cartilage transplantation at age 11. At adult evaluation, the nasal root was low, and the previously reconstructed L-strut was undersized for the matured facial skeleton, resulting in a short nose deformity. Revision surgery used re-harvested costal cartilage for dorsal and L-strut reconstruction and auricular dermochondral grafts for lining and rim support. Costal cartilage was readily available from the prior donor site, while auricular cartilage was limited due to previous use and donor-site concerns. Two years postoperatively, nasal aesthetics and facial balance improved markedly, with high patient and family satisfaction. This case underscores the importance of anticipating postpubertal facial growth, planning early reconstruction accordingly, selecting grafts strategically, and recognizing the likely need for secondary reconstruction in adulthood.