Evolution of the Septal Extension Graft in Endonasal Rhinoplasty: Long-Term Efficacy and Reliability.

BACKGROUND: Proper nasal tip projection and rotation have a strong impact on nasal aesthetics. Septal extension graft is one of the tools used to improve tip projection and rotation when performing rhinoplasty. This graft typically overlaps the existing caudal septum in the midline position, lengthening it and facilitating the repositioning of the tip.

OBJECTIVES: To describe the technical evolution of the septal extension graft in endonasal rhinoplasty and evaluate the reliability and long-term efficacy of the current technique.

METHODS: Evaluation of pre- and post- surgical photographs of the nasolabial angle and nasal proportions in 60 patients who underwent endonasal rhinoplasty with septal extension graft.

RESULTS: The study demonstrated a clear improvement in tip projection and rotation at the one-year follow-up. The mean pre-operative nasolabial angle was 93.75±9.45° compared with 101.1±5.3° following surgery. Although both were normally distributed, the range of the post-operative nasolabial angle was narrower than one-year pre-operatively (SD=5.3° vs. 9.45°, respectively). The Crumley ratio, used to describe nasal proportions, presented significant changes in nasal proportions: 3.84 pre-operatively and 4.04 post-operatively (95%CI: -0.24 to -0.149; P<0.001).

CONCLUSIONS: The use of septal extension graft in endonasal rhinoplasty has significantly changed since first described in 2006. The adaptations made to this technique render it more reliable and our study demonstrates its efficacy in improving tip projection and rotation over the long-term.