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The 5th costal cartilage and rib were removed and five silk sutures were placed into a 7-mm wound of the myocardium.
The patient subsequently underwent open nasoseptorhinoplasty with a caudal septal extension graft, V-Y columellar lengthening, spreader grafting, and a combined dorsal strut/shield graft using costal cartilage.
Costal cartilage is an additional option, but most patients prefer the reduced morbidity of an auricular graft and the advantage of a hidden incisional scar.