A Modified Technique of Septal Extension Using a Septal Cartilage Graft for Short-Nose Rhinoplasty in Asians

Abstract

An aesthetically short nose is very common in Asians. In the past few decades, rhinoplasty in China has focused mainly on the augmentation of the dorsum with alloplastic materials. Alloplastic materials used to augment the nasal tip or for nose lengthening rhinoplasty present a high risk of complications. Therefore, a recent trend in controlling tip projection and rotation is to use an autogenous cartilage graft in Asians. A strong septal extension is mandatory to increase the tip projection and lengthen the nose due to inadequate and inflexible nasal skin in short-nosed patients, whereas cap-and-shield grafting or defattening of the dome or suture modification are used only as additional methods, if necessary. Between January 2008 and February 2012, a total of 113 Chinese patients (female-to-male ratio = 101:12) with different degrees of shortened noses, saddle noses, and/or round nasal tip deformities underwent open rhinoplasty. Silicone implants were used for nasal dorsum augmentation in 29 patients and e-PTFE was used in 84 patients. To evaluate the outcomes, nasal length, nasal tip projection, and nasolabial angle were measured pre- and postoperatively in 53 cases. The harvestable septal cartilage were carved into "a" and "b" strips, which were sutured in a "V" shape structure to extend the septum. Of 113 cases, 78 patients were followed up for an average of 15 months (range = 1 month to 3 years). No major complications associated with implants or e-PTFE during the follow-up period were reported, with the exception of six cases with silicone dorsum augmentation that had an operative look. The results showed that statistically significant differences existed between the pre- and postoperative values in nose length and nose tip projection (p < 0.05). The nasolabial angle presented a reduced trend, although no statistically significant difference was found. With limited harvestable septal cartilage, the modified technique of septal extension with a septal cartilage graft (or combined with auricular cartilage) is feasible and can effectively improve tip contour in short-nose rhinoplasty. This journal requires that authors assign a level of evidence to each article.