An Introduction to the Septal Extension Graft

The septal extension graft is a very useful method of controlling nasal lengthening and tip projection, rotation, and shape by fixing a graft to the septum, which leads to a strong supporting structure. Enhancing graft stability is important for better long-term outcomes and minimizing complications or relapse, and even more efficient application of these methods is needed for East Asians who lack enough cartilage to be harvested in addition to possessing a weak cartilage framework. In this paper, the methods for overcoming the drawbacks of the septal extension graft, such as instability, a fixed tip, and insufficiency of cartilage, are presented, and the applications of each method for greater satisfaction with surgical outcomes are also discussed.

Keywords

Rhinoplasty - Nasal septum - Transplantation, autologous

• REFERENCES

• 1 Byrd HS, Andochick S, Copit S. et al. Septal extension grafts: a method of controlling tip projection shape. Plast Reconstr Surg 1997; 100: 999-1010
• 2 Ha RY, Byrd HS. Septal extension grafts revisited: 6-year experience in controlling nasal tip projection and shape. Plast Reconstr Surg 2003; 112: 1929-1935
• 3 Hubbard TJ. Exploiting the septum for maximal tip control. Ann Plast Surg 2000; 44: 173-180
• 4 Oh SH, Kang NH, Woo JS. et al. Stabilization of unilateral septal extension graft using pivot locking suture. J Korean Soc Aesthetic Plast Surg 2008; 14: 156-160
• 5 Han K, Jin HS, Choi TH. et al. A biomechanical comparison of vertical figure-of-eight locking suture for septal extension grafts. J Plast Reconstr Aesthet Surg 2010; 63: 265-269
• 6 Tebbetts JB. Primary rhinoplasty: a new approach to the logic and the technicques. St. Louis: Mosby; 1998
• 7 Lee HJ. New septal extension graft by "interdigitation" in asian nasal tip plasty. In: 2nd International Congress of Minimal Invasive Plastic Surgery and Dermatology; 2010 Sep 10-12 Seoul: MIPS Committee; 2010: 239
• 8 Hwang SH, Hwang K. Supporting strength of septal extension grafts. J Craniofac Surg 2011; 22: 2323-2326
• 9 Cho TY. Tripod projection and lengthening by septal extension graft In: 7th Asan Rhinoplasty rhinoplasty Symposium; 2009 May 8-10; Seoul 2009; 49-53
• 10 Tebbetts JB. Shaping and positioning the nasal tip without structural disruption: a new, systematic approach. Plast Reconstr Surg 1994; 94: 61-77
• 11 Kim JS, Choi JH, Choi TH. et al. Modified septal extension graft for the correction of nasal tip and columella. J Korean Soc Plast Reconstr Surg 2006; 33: 681-687
• 12 Kim JS, Han KH, Choi TH. et al. Correction of the nasal tip and columella in Koreans by a complete septal extension graft using an extensive harvesting technique. J Plast Reconstr Aesthet Surg 2007; 60: 163-170
• 13 Pham AM, Tollefson TT. Correction of caudal septal deviation: use of a caudal septal extension graft. Ear Nose Throat J 2007; 86: 142 4
• 14 Seyhan A, Ozaslan U, Sir E. et al. Three-dimensional modeling of nasal septal deviation. Ann Plast Surg 2008; 60: 157-161
• 15 Jang YJ, Yu MS. Rhinoplasty for the Asian nose. Facial Plast Surg 2010; 26: 93-101
• 16 Daniel RK. Rhinoplasty: an atlas of surgical techniques. 1st ed. New York: Springer-Verlag; 2001
• 17 Seyhan A, Ozden S, Ozaslan U. et al. A simplified use of septal extension graft to control nasal tip location. Aesthetic Plast Surg 2007; 31: 506-511
• 18 Huang J, Liu Y. A modified technique of septal extension using a septal cartilage graft for short-nose rhinoplasty in Asians. Aesthetic Plast Surg 2012; 36: 1028-1038
• 19 Kim JH. Surgical guides for overcoming disadvantages of septal extension graft in Asians. In: 7th Asan Rhinoplasty Symposium; 2009 May 8-10; Seoul 2009; 54-57
• 20 Pitanguy I, Salgado F, Radwanski HN. et al. The surgical importance of the dermocartilaginous ligament of the nose. Plast Reconstr Surg 1995; 95: 790-794
• 21 Rohrich RJ, Huynh B, Muzaffar AR. et al. Importance of the depressor septi nasi muscle in rhinoplasty: anatomic study and clinical application. Plast Reconstr Surg 2000; 105: 376-383
• 22 O'Keeffe PJ. Dynamic rhinoplasty for the plunging nasal tip: functional unity of the inferior third of the nose. Plast Reconstr Surg 2001; 108: 1825-1827
• 23 Suh MK. Contracted short nose correction using irradiated homologous costal cartilage. J Korean Soc Aesthetic Plast Surg 2010; 16: 117-124
• 24 Suh MK, Ahn ES, Kim HR. et al. A 2-year follow-up of irradiated homologous costal cartilage used as a septal extension graft for the correction of contracted nose in Asians. Ann Plast Surg 2013; 71: 45-49
• 25 Han KH, Jeong JW, Park MS. et al. Complete septal extension graft using porous high-density polyethylene sheet or septal cartilage in unilateral cleft lip nasal deformities: photogrammetric analysis. J Korean Soc Plast Reconstr Surg 2010; 37: 400-408
• 26 Han K, Jeong JW, Kim JH. et al. Complete septal extension grafts using porous high-density polyethylene sheets for the westernization of the Asian nose. Plast Reconstr Surg 2012; 130: 106e-115e
• 27 Sen C, Iscen D. Caudal septal advancement for nasal tip projection and support in rhinoplasty. Aesthetic Plast Surg 2006; 30: 135-140
• 28 Guyuron B, Varghai A. Lengthening the nose with a tongue-and-groove technique. Plast Reconstr Surg 2003; 111: 1533-1539
• 29 Kang JG, Ryu J. Nasal tip surgery using a modified septal extension graft by means of extended marginal incision. Plast Reconstr Surg 2009; 123: 343-352