Bilateral Fan-Shaped Septal Extension Struts in East Asian Augmentation Rhinoplasty

Wang H, Wu L, Xu Y, Fan F, You J.

PubMed 32322931 Publisher (DOI)

What this paper says

In 52 women having rib cartilage augmentation rhinoplasty with a new paired fan shaped strut, there were no graft extrusions or infections, and three patients needed revision for warping or crooked nostrils by 12 months.

Overview

Rib cartilage can bend after it is placed, which is a problem when a single strut supports the nasal tip. The authors describe a design using a pair of fan shaped cartilage grafts fixed to both sides of the septum, sandwiching it. The paired structure is intended to perform the combined jobs of a columellar strut and a septal extension graft. Fifty two female patients aged 18 to 37 had augmentation rhinoplasty using it.

Sections of note

Case series of 52 female patients, age range 18 to 37; the journal assigns level of evidence IV.
Twenty of the cases were primary, 26 secondary and 6 tertiary, so most patients had already had nasal surgery.
The graft pair is bilaterally fixated to the septum, forming a sandwiched structure.
Patients' own ratings of overall improvement gave what the authors call a high satisfaction rate; no scoring instrument or numbers are stated.
No case of graft extrusion or infection occurred.
One case had warping of the dorsal onlay graft during long term follow up.
Two cases had significantly asymmetric nostrils from columellar deviation at 12 months and were corrected at revision surgery.

What it means for a patient

The design targets a specific known failure, a single rib strut bending and pulling the tip off center.
Three of 52 patients still had a graft or alignment problem needing further surgery.
Satisfaction was self reported without a validated questionnaire, and there is no comparison group using the standard single strut.
Most patients in this series were revision cases, so the results may not transfer to first time surgery.

Why this paper matters

Tip support in rib based augmentation is the durability problem in East Asian rhinoplasty, and warping is its main cause of late failure. This paper offers a structural answer and reports outcomes at 12 months. Whether the paired strut outperforms existing designs has not been tested head to head.

Terms

Septal extension graft: a cartilage graft attached to the septum to set the position of the nasal tip.
Columellar strut: a cartilage post placed between the nostrils to support the tip.
Warping: gradual bending of a cartilage graft after surgery.
Extrusion: a graft working its way out through skin or lining.
Onlay graft: cartilage laid on the bridge to add height.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

From the abstract

“For costal cartilage-based rhinoplasty, a method that could properly manage warping of the columellar strut graft and facilitate establishing a stable cartilaginous framework remains desirable. In this study, the authors present a new graft design named bilateral septal extension strut. It utilizes a pair of cartilage…”

Excerpt; the full abstract is on PubMed.