Combining Preservation and Structured Rhinoplasty: Septal Extension Grafts and the Interdomal Hanger

Nakamura F, Luitgards BF, Ronche Ferreira JC.

PubMed 33564570 Publisher (DOI)Free full text (PMC)

What this paper says

The authors describe a technique combining a septal extension graft with preservation of the tip ligaments, in which the interdomal ligament is stabilized above the graft as a supporting sling.

Overview

Preservation rhinoplasty focuses on keeping and reshaping existing nasal structures. The authors state some patients are not good candidates for it, specifically those with an underprojected nose and thick skin, who need a septal extension graft to support and define the tip. The article describes a way to use that graft while still preserving the tip ligaments.

Sections of note

Technique description; the abstract reports no patient numbers, no outcomes, no complication rates and no follow up.
The named technique is the interdomal hanger.
It consists of preserving the interdomal ligament and stabilizing it above the septal extension graft.
The preserved ligament then acts as a suspensory sling.
The stated benefit is increased tip support in both rotation and projection.
The authors present this as mixing important steps of preservation rhinoplasty with the support of a septal extension graft.

What it means for a patient

A thick skinned nose with a low tip generally needs added structural support that preservation alone does not supply.
This technique keeps a ligament that structural rhinoplasty normally divides.
No results are reported, so there is no evidence here that tip position holds better than with the standard method.
No comparison with a septal extension graft used without ligament preservation is presented.

Why this paper matters

Preservation and structural rhinoplasty are often framed as competing philosophies, and hybrid techniques are how surgeons reconcile them in patients who fit neither cleanly. This article describes one such hybrid. Whether preserving the ligament adds measurable support has not been tested.

Terms

Preservation rhinoplasty: keeping and repositioning existing nasal structures rather than removing and rebuilding.
Septal extension graft: cartilage attached to the septum to set the position and projection of the tip.
Interdomal ligament: the fibrous band connecting the two domes of the tip cartilages.
Tip projection: how far the tip stands out from the face.
Underprojected nose: a nose whose tip sits closer to the face than intended.

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

Abstract

Preservation rhinoplasty is a new philosophy in the field of rhinoplasty, focusing on preserving and reshaping nasal structures. However, the authors suggest some patients are not good candidates for preservation rhinoplasty. Patients with underprojected noses and thick skin need a septal extension graft for tip support and to achieve maximum tip definition. In this article, we describe a new technique to combine septal extension graft with the preservation of tip ligaments, called interdomal hanger. It allows the surgeon to benefit from increased tip support in rotation and projection. The technique consists of the preservation of the interdomal ligament, which is then stabilized above the septal extension graft working as a suspensory sling. With this technique, the surgeon can mix important steps of preservation rhinoplasty and benefit from the support of the septal extension grafts.

Abstract as indexed by PubMed; the article is open access (PubMed Central).