APS Aesthetic Plastic Surgery · 2025

An Innovation Technique in East Asia Rhinoplasty

Wang S, Wang X, Xiang X, Song D, Xiao M, Yu Z, Sun Y, Xiong X, Meng X, Li W, Yi Z, Qiao Z.

PubMed 39179657 Publisher (DOI)Free full text (PMC)

What this paper says

In 41 East Asian patients treated with a rib cartilage framework built outside the septum, satisfaction scores rose from 11.85 to 17.43 with no complications over an average 19.85 months.

Overview

The authors describe an external septal framework, in which the support structure is assembled from rib cartilage without dissecting the patient's own septum. The columellar strut and the external septal graft are joined by a tongue in groove fit to support and lengthen the tip. Patients were treated at a university hospital between November 2021 and April 2023.

Sections of note

Design: case series, 41 patients, 9 men and 32 women, aged 17 to 48. Level of evidence V.
The sixth or seventh rib cartilage supplied the columellar strut, external septal graft, cap grafts and shield grafts. Rectus abdominis fascia covered the tip, and a sculpted ePTFE implant augmented the bridge.
Average follow up 19.85 months. No short or long term complications were observed.
Rhinoplasty Outcome Evaluation rose from 11.85 to 17.43 and visual analog score from 4.86 to 8.48. 88.9 percent were satisfied.
Nasolabial angle rose from 86.11 to 98.66 degrees, nasal length from 39.43 to 42.17 millimetres, and median tip projection from 1.84 to 2.15 centimetres.

What it means for a patient

Building the framework outside the septum avoids dissecting it, which preserves the patient's own septal cartilage for any future need.
A synthetic ePTFE implant was used on the bridge alongside the patient's own cartilage at the tip, so this is a mixed approach rather than fully autologous.
Roughly one in nine patients was not satisfied despite the reported measurements improving.
Limits: 41 patients, single centre, no comparison group, level V evidence, and follow up under two years for a construction that includes a permanent implant.

Why this paper matters

East Asian rhinoplasty usually adds volume, and the septum often cannot supply enough cartilage for a support framework. Building the framework independently of the septum sidesteps that. Whether the synthetic bridge implant carries the extrusion and infection risks associated with such materials over years is not addressed.

Terms

External septal framework: a support structure assembled from graft cartilage without dissecting the septum.
Tongue in groove: a joint where a projection on one piece slots into a channel in another.
Costal cartilage: cartilage from the ribs, harvested for use as a graft.
ePTFE: expanded polytetrafluoroethylene, a porous synthetic implant material.
Shield and cap grafts: cartilage pieces placed on the tip to shape and project it.

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

Abstract

Objective: To investigate the application and therapeutic efficacy of a novel cartilage framework: the external septa framework in East Asian rhinoplasty.

Methods: From November 2021 to April 2023, Department of Plastic and Aesthetic (Burn) Surgery, the Second Xiangya Hospital, Central South University, treated 41 patients with autologous costal cartilage rhinoplasty using an innovation external septal framework. The surgical open approach used an inverted V-shaped trans-columellar incision and marginal incision. The sixth or seventh costal cartilage was harvested to form the nasal columella support grafts (strut), external nasal septal graft, cap grafts, and shield grafts, in which the nasal column support graft and external nasal septal graft are connected in a way of tongue in groove to form a external septum framework to support and lengthen the tip. A cap graft is used to shape the tip of the nose, the rectus abdominis fascia is used to cover the tip of the nose, and the shield grafts are used to augment the inferior lobules. ePTFE was sculpted according to the degree of augment of the nasal dorsum and implanted on the dorsal to augment the nasal dorsum. Clinical outcomes were assessed through standard facial photographs taken during the preoperative and follow-up periods, and a postoperative satisfaction survey was completed with regular follow-up using the rhinoplasty outcome evaluation scale (ROE) and visual analogue scale (VAS). Results of objective and subjective measurements before and after surgery were compared utilizing paired-sample t tests. Values of P < 0.05 were considered significant. Nasal framework's objective evaluation outcomes were assessed by measuring the patients' preoperative and postoperative nasolabial angle, nasal length, and nasal tip projection. (The distance between the pronasale and the alar-cheek junction was calculated as the tip projection.) The comparison of preoperative and postoperative nasolabial angle and nasal length was performed using the paired-sample t test, and the comparison of nasal tip projection was performed using the Wilcoxon signed rank-sum test for the comparison of paired samples. Values of P < 0 .05 were considered significant.

Results: A total of 41 patients were treated, including 9 males and 32 females, ranging in age from 17 to 48 years(32.8 ± 1.5 years old), In the study, an average follow-up period of 19.85 ± 4.88 months was observed (range 12-29 months). There was no long-term or short-term complication observed. The aesthetic outcome of all cases such as saddle nose, deviated nasal columella, bilateral asymmetry of the nose, bilateral nasal base depression, and bulbous tip was satisfactory. Patient satisfaction evaluation: The ROE scale was (11.85 ± 2.46) preoperatively and (17.43 ± 2.15) postoperatively. The VAS scores were (4.86 ± 1.60) preoperatively and (8.48 ± 1.25) postoperatively. The difference of ROE scale and VAS scores among the patients was statistically significant (P < 0. 05), and 88.9% of patients were satisfied following those procedures. In terms of nasolabial angle, preoperative and postoperative measurements of 41 patients were (86.11 ± 2.25)° and (98.66 ± 1.90)°, respectively, and the difference of nasolabial angle was statistically significant (P < 0.05); nasal length measurements were 39.43 ± 1.55 mm (37.95-43.51 mm) preoperatively and 42.17 ± 1.46 mm (40.23-45.62 mm) postoperatively; in terms of nasal tip projection, preoperative and postoperative measurements of median values were 1.84(1.73,2.01) cm and 2.15(2.02,2.32) cm, respectively; and the difference between preoperative and postoperative values was statistically significant (P < 0.05).

Conclusions: The innovative cartilage framework-external septal framework, avoids the dissection of septa and absorption of septal cartilage with compression of ESG, it is easy to be performed, and it is also stable and strong to achieve in good aesthetic result.

Level Of Evidence V: 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).