Nasal Tip Surgery Using a Modified Septal Extension Graft by Means of Extended Marginal Incision

Abstract

The columellar strut is considered one of the standard procedures in nasal tip surgery, as it provides a structural foundation for the nasal tip. Although effective for most Caucasians, the columellar strut often results in a suboptimal outcome and does not provide an adequate foundation in Asian tip surgery. For an optimal outcome, the authors propose a different surgical paradigm for Asian tip surgery. Using an extended marginal incision, a wide-field endonasal dissection is performed and the distal nasal framework including the alar cartilages and the caudal septum is exposed widely. A septal extension graft is made from a preoperatively designed paper template, with markings for anchoring the alar cartilage and overlapping with the caudal septum. The extension graft is fixed to the caudal septum and the alar cartilages are sutured to the extension graft at the precise position using markings transferred to the extension graft. This procedure was applied in 217 Asian rhinoplasties, with all patients having substantial improvement in their nasal tip shape. The advantages of this technique are numerous and include stable tip support and versatility in nasal tip modification. The same basic techniques and sequence can be applied to correct a wide range of tip deformities found in Asian noses. The authors' surgical paradigm combining the modified septal extension graft with wide-field endonasal dissections provides a unique opportunity to gain greater control and a more predictable outcome in Asian tip surgery. Stable septal support is crucial to the success of this technique.