Effect of Modified Septal Extension Grafts on the Nasal Tip in Rhinoplasty

Overview

Progressive loss of tip projection and rotation after surgery is a recurring difficulty in tip work. Stabilizing the base of the nose with a septal extension graft has been shown to reduce that loss. The authors present a modified version in which changing the angle at which the graft is inserted sets the required rotation, while avoiding a rigid tip and requiring less cartilage.

Sections of note

• Retrospective review of 37 patients having open rhinoplasty, primary or secondary, over a 12 month period.
• Average patient age 28 years, range 20 to 43; all patients were of Middle Eastern origin.
• Assessment was subjective evaluation based on photographic analysis before and after surgery.
• All cases maintained their operative result for tip rotation.
• Two cases showed a minimal decrease in tip projection at 6 to 12 months after surgery.
• No patient required secondary revision surgery for changes in tip projection or rotation.
• The authors state the graft can both rotate the tip upward and derotate a tip that is rotated too far.
• They state it maintains tip projection without a rigid tip and needs less cartilage than a standard graft.

What it means for a patient

• The graft angle determines whether the tip is lifted or lowered, so one design serves both purposes.
• Using less cartilage matters when the septum is limited or has already been harvested.
• Assessment was described by the authors themselves as subjective, based on photographs, with no validated scoring.
• Thirty seven patients from one group with no comparison arm is limited evidence.

Why this paper matters

Tip position tends to settle downward in the year after surgery, and septal extension grafts are the standard countermeasure at the cost of a stiff tip and a large cartilage requirement. This modification targets both costs. Whether it holds position as well as a standard graft over years is untested.

Terms

• Septal extension graft: cartilage attached to the septum to set the position and projection of the tip.
• Tip projection: how far the tip stands out from the face.
• Tip rotation: how far upward the tip is angled.
• Derotation: rotating an over lifted tip back downward.
• Open rhinoplasty: surgery through an incision across the columella, lifting the nasal skin.