Correction of Short Nose Deformity Using a Septal Extension Graft Combined with a Derotation Graft

AbstractThe short nose represents one of the greatest challenges in rhinoplasty. It is characterized by a reduced distance from the nasal radix to the tip-defining points, often associated with inadequate tip projection. Several techniques have been described for correction of short nose with the common objective of replacing and rebuilding the osteocartilaginous framework. One of the most effective method to correct the short nose is the septal extension graft. The authors describe the caudal septum pivot (CSP) technique, a simple method to elongate short noses by using a graft inserted in the dorsal septum after its division using as pivot the caudal portion, without detaching it from its natural anchorage to the anterior nasal spine. A retrospective analysis was performed reviewing the clinical charts and the operative records of 315 patients who underwent revision rhinoplasty from January 2015 to June 2019; among this group, 34 were considered eligible for the study. The patients (8 men, 26 women; mean age: 25.4 years; age range: 22–53 years) were divided into two groups: in 12 patients (Group 1) the CSP technique was performed, while Group 2 was composed of 22 patients who received a more classic treatment with a septal extension graft. To evaluate the outcomes, nasal length, tip projection, and tip rotation were measured pre- and 1 year postoperatively on digital photographs of each patient. Nasal anthropometric measurements revealed, at 12-month visit follow-up, an improvement in nasal length, tip projection, and nasolabial angle was achieved in all the patients. The comparison of the pre- and postoperative values showed a statistically significant reduction in the nasolabial angle (p < 0.05) and an increase in the tip projection (p < 0.05) and in the nasal lengthening (p < 0.05) in both groups. In authors' experience, the CSP technique could be considered a safe, reliable, and effective alternative technique in selected patients.

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Septal Extension Graft in “Closed” Revision Rhinoplasty: A Simplified Technique

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2017.31.4442 ◽

2017 ◽

Vol 31 (4) ◽

pp. 260-264 ◽

Cited By ~ 2

Author(s):

Alberto Scattolin ◽

Pier-Francesco Galzignato ◽

Fabrizio Longari ◽

Luca D'Ascanio

Keyword(s):

Endonasal Approach ◽

Short Nose ◽

Tip Projection ◽

Septal Extension Graft ◽

Revision Rhinoplasty ◽

Aesthetic Results ◽

The Aesthetic ◽

Extension Graft ◽

Nasal Length ◽

Preoperative Examination

Background The septal extension graft (SEG) is widely used in secondary rhinoplasty for correction of a short nose with loss of tip support and projection, columellar retraction, and hyper-rotated tip secondary to an overresection of the caudal septum. Although SEG precise fixation can be relatively easy in the external approach, the difficulties of SEG placement in “closed” rhinoplasty can be discouraging. Objective To describe an easy surgical technique for SEG placement in endonasal revision rhinoplasty and to analyze the aesthetic results of the procedure. Methods Thirty-eight patients were submitted to an endonasal approach revision rhinoplasty with endonasal placement of SEG for the correction of a short nose with a hypoprojected and hyper-rotated nasal tip. Pre- and postoperative nasal length, tip projection, and tip rotation (nasolabial and lobulocolumellar angles) were measured for each patient. Results An increase (mean ± standard deviation) of nasal length by 15.02 ± 3.91% and an augmentation of tip projection by 11.34 ± 2.26% were noticed after surgery with respect to preoperative conditions. A significant (p < 0.001) decrease in the columellar-labial angle was recorded on postoperative (91.23 ± 3.85°) examination with respect to preoperative (99.81 ± 6.49°) conditions. A decrease (p < 0.001) in the columellar-lobular angle was noted on postoperative assessment (34.02 ± 5.28°) with respect to preoperative examination (50.02 ± 0.36°). No relevant postoperative complication was recorded. Conclusion The “endonasal” approach described for SEG placement was an easy and reliable procedure to treat a short nose with loss of tip support and projection, columellar retraction, and hyper-rotated tip, especially in revision surgery. The advantages of our technique over previously described approaches were reported.

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