Surgical management of the distorted caudal septum.

PURPOSE OF REVIEW: This article reviews the current trends in the surgical approach to the caudal septum, and its importance in rhinoplasty. The evolution of rhinoplasty techniques over the past half century has changed the emphasis from excessive cartilage resection, and a plethora of grafts and sutures, to a more conservative approach that seeks to maintain the function of the nose and create a naturally beautiful, 'not-operated' look. RECENT FINDINGS: New anatomical studies continue to shed light on the importance of soft-tissue support, and the mechanical properties of the caudal septum. When applied to surgical techniques, these new findings emphasize the principles of adequate preoperative history and examination, nasendoscopy, and facial analysis. On the basis of these clinical findings, a unique, tailor-made rhinoplasty game plan can be created for each patient that should not be used for another operation. Several techniques have emerged from the natural evolution of rhinoplasty that produce controlled, reversible effects in a predictable, stepwise manner. SUMMARY: The caudal septum plays a key role in nasal airflow, provides support for the nasal tip, and affects the alar-columellar relationship. Deviation at the caudal septum creates some of the commonest problems in aesthetic rhinoplasty.Through new anatomical knowledge and advances in rhinoplasty techniques, the vast majority of these problems can be approached through an endonasal/hybrid rhinoplasty approach. Hybrid rhinoplasty refers to a distillation of best of both worlds of external and endonasal surgery over the past 40 years.The key to a successful outcome relies on adequate clinical examination, nasendoscopy, detailed surgical facial analysis, and a well planned surgical game plan. VIDEO ABSTRACT: SDC 1 (http://links.lww.com/COOH/A9).