Versatility of the Fixed-Mobile Septal Extension Graft for Nasal Tip Reshaping

Abstract

Key goals of nasal tip reshaping include precise control of tip shape and position, along with restoration of proper structural support. Unfortunately, traditional techniques attempting to address these goals have yielded unpredictable results. In this article, the authors detail their surgical technique and discuss the numerous aesthetic and functional benefits of this graft, along with its applicability to a wide variety of patient populations and nasal deformities. The authors' technique utilizing the fixed-mobile septal extension graft has demonstrated reliability in establishing proper tip positioning through precise adjustments to tip rotation and projection, while simultaneously providing a stable structure for maintaining tip support. While fixed at the anterior septal angle, this graft also proves beneficial in maintaining natural tip mobility because of its anterior extension past the septum. The fixed-mobile septal extension graft is versatile and reliable when used for tip reshaping and support.

Beyond Alar Base Resection – Contouring of the Alar Rim and Base

“…Furthermore, the implementation and refinement of the septal extension graft has had huge implications for management of the alar base. 16,25,26 This graft is described in a "fixed-floating" fashion, which allows for it to be used as a stable post to project, deproject, rotate, and derotate the nasal tip. An added benefit of the septal extension graft is that it allows for the medial and lateral crura of the lower lateral cartilages to be tensioned, thereby achieving a diamond-shaped tip and ideally contoured peridomal area and columella.…”

“…This is because modifying aspects of the lower third or the nose (tip projection, tip rotation, and columellar position/contour) can impact the alar base, nostril sill, and alar flare. 7,14,17,25,26 For this reason, it is the senior author’s practice to discuss the possibility of alar base surgery with all patients before they undergo rhinoplasty. That being said, understanding the dynamic relationship between the nasal tip and the alar base can help to predict the need for alar base surgery.…”

Reconstruction of Nasal Tip Using “Seagull-shaped” Cavum Concha Cartilage Composite Scaffold

“…There are various methods available to improve the nasal tip, including nasal tip suture techniques and various nasal tip grafting techniques 2–4 . For individuals of Asian descent, nasal tip grafts can be particularly effective in enhancing the projection, rotation, and definition of the nasal tip 5,6 …”

“…[2][3][4] For individuals of Asian descent, nasal tip grafts can be particularly effective in enhancing the projection, rotation, and definition of the nasal tip. 5,6 The most commonly used grafts in clinical practice are autologous cartilage grafts, which primarily include ear cartilage, nasal septum cartilage, and rib cartilage. 7 Among these, ear cartilage is preferred due to its inherent elasticity and compliance, making it the most suitable graft material.…”