A Modified Septal Extension Graft for the Asian Nasal Tip

Importance Septal extension graft is an effective procedure in tip plasty because it can provide stable structural support for the nasal tip. However, in Asian patients septal cartilage is much weaker, thinner, and smaller than that of white people, causing the existing caudal septal cartilage and the septal extension graft to deviate to the opposite side of graft placement. Objective To introduce an effective and reliable modified septal extension graft in tip plasty. Design, Setting, and Participants Observational study of a total of 143 patients (84 undergoing primary rhinoplasty and 59 undergoing secondary rhinoplasty). Intervention A modified septal extension graft technique in combination with other procedures, including tip graft and implant augmentation. Main Outcome and Measure Subjective evaluation based on photographic analysis. Results This procedure was applied in 143 Asian patients, with substantial improvement seen in the nasal tip of all patients except for 3 (1 for the overprojected nasal tip and 2 for bending of existing caudal septum). Other complications included infection in 1 patient and implant deviation in 1 patient; the implant and grafts were removed 10 days after surgery in the patient with infection. The other patient underwent revision 3 months after surgery for the deviated implant. Conclusions and Relevance This technique is an effective method to provide long-term, stable nasal tip support. It helps to set the existing caudal septum and the septal extension grafts exactly at the anterior midline and decrease the deviation of the nasal tip. Level of Evidence 4.