M-Shaped Auricular Cartilage as Modified Septal Extension Graft: A Study by Three-Dimensional Anthropometric Analysis in Asian Rhinoplasty

Wang D, Hou K, Zeng N.

PubMed 33758974 Publisher (DOI)Free full text (PMC)

What this paper says

In 36 patients given an M-shaped ear cartilage graft to set the nasal tip, 91.7 percent were satisfied and eight of thirteen three dimensional measurements increased significantly with no infections or graft exposure.

Overview

Septal extension grafts are among the most used grafts in Asian tip surgery, but the authors state they usually leave the tip hard and immobile. This study evaluated a modified version using ear cartilage folded into an M shape, combined with a silicone implant, and assessed the results with three dimensional measurement of the face.

Sections of note

Case series of 36 patients; the journal assigns level of evidence IV.
All had augmentation rhinoplasty with the M-shaped ear cartilage graft plus a silicone implant.
Thirteen measurement items were assessed with three dimensional techniques before and after surgery.
Most patients, 91.7 percent, were satisfied with the postoperative nasal shape.
No infection, gross absorption, graft exposure, implant exposure or implant migration was observed.
Nasal length, nasal height, nasal depth, nasion height, columella width, nasolabial angle, nasofrontal angle and the nasal depth to width index all increased significantly.
Nasal width, nasal tip width and the nasal index all decreased significantly.
The authors state the technique achieved a soft and mobile tip with satisfying projection in most patients.

What it means for a patient

The stated advantage over a standard septal extension graft is a tip that still moves and feels natural.
Ear cartilage avoids taking septal cartilage or a rib, though it leaves a small ear incision.
The series also used a silicone implant, so the measured changes reflect both together, not the graft alone.
Thirty six patients with no comparison group and no stated follow up duration is limited evidence.

Why this paper matters

Tip rigidity is a recurring complaint after septal extension grafting, and softening it without losing support is the design problem. This study reports one solution with objective three dimensional measurements. Whether the tip stays in position over years is not addressed.

Terms

Septal extension graft: cartilage attached to the septum to set the position and projection of the tip.
Auricular cartilage: cartilage taken from the ear.
Three dimensional anthropometry: measuring facial dimensions from a digital three dimensional scan.
Nasion: the point at the root of the nose between the eyes.
Nasal index: the ratio of nasal width to nasal height.
Graft exposure: a graft becoming visible through the skin or lining.

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

Abstract

Background: The septal extension graft is one of the most commonly used grafts in Asian tip plasty techniques. However, the septal extension graft usually induces a hard and immobile nasal tip. The purpose of this study was to evaluate the esthetic outcomes of the modified septal extension graft with M-shaped auricular cartilage by three-dimensional anthropometric analysis.

Methods: A total of 36 patients received augmentation rhinoplasty with M-shaped auricular cartilage as septal extension graft combined with silicone implant. Thirteen measurement items were evaluated using three-dimensional anthropometric techniques, and the preoperative and postoperative results were compared.

Results: The majority of patients (91.7%) were satisfied with the postoperative nasal shape. No infection, gross absorption, graft exposure, implant exposure, or implant migration was observed. Compared with the preoperative value, the nasal length, nasal height, nasal depth, nasion height, columella width, nasolabial angle, nasofrontal angle, and nasal depth-nasal width index significantly increased. The nasal width, nasal tip width, and nasal index significantly decreased.

Conclusion: We performed tip plasty with the M-shaped auricular cartilage as modified septal extension graft, achieving a soft and mobile tip with satisfying tip projection in most patients.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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