Septal Extension Graft in Asian Rhinoplasty

Overview

A septal extension graft attaches to the septum and projects forward, giving the tip a fixed anchor. It has dominated Asian rhinoplasty alongside synthetic dorsal implants. The authors note that this combination has produced its own complications and describe an L-strut variant addressing them.

Sections of note

• A septal extension graft can control nasal tip projection, shape, and rotation.
• Septal extension grafts and dorsal alloplastic implants have predominated in Asian rhinoplasty.
• That predominance has led to surgeon-caused complications including a foreshortened nose and destruction of the remaining septum.
• The septal L-strut extension graft enhances the lower two-thirds of the nose forward and downward in Asians with relatively small noses.
• It is indicated in primary cases where the bony bridge is acceptable but the cartilaginous bridge is relatively underdeveloped.
• It is also indicated in secondary cases with a surgeon-caused short-nose deformity from synthetic implants.
• The abstract reports no patient numbers, complication rates, outcomes, or follow-up.

What it means for a patient

• The tip position is anchored to the septum rather than propped on a loose strut, which the authors describe as more controllable.
• Aggressive use of septal grafts can consume the septum itself, leaving less for any later operation.
• A nose shortened and pulled up after implant surgery is one of the specific problems this graft is used to correct.
• This is a review with no measured outcomes, so it does not report success or complication rates.

Why this paper matters

The septal extension graft is now a standard tool in Asian rhinoplasty, and this documents both its uses and the complications its widespread use has generated. Preserving remaining septum is the practical concern. No data is offered comparing the L-strut variant to the conventional graft.

Terms

• Septal extension graft: A cartilage piece attached to the septum and projecting forward to set tip position.
• L-strut: The L-shaped strip of septal cartilage along the bridge and base that holds the nose up.
• Alloplastic implant: A synthetic implant, as opposed to the patient's own tissue.
• Foreshortened or short nose: A nose pulled upward so it appears shortened and the nostrils overly visible.
• Iatrogenic: Caused by the medical treatment itself.
• Hypoplastic: Underdeveloped or smaller than normal.