0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

A Modified Septal Extension Graft for the Asian Nasal Tip

Jinde Lin, MD1; Xiaoping Chen, MD1; Xin Wang, MD1; Xia Gao, MD1; Xiangyu Zheng, MD1; Xin Chen, MD1; Yugang Yuan, MD1
[+] Author Affiliations
1Nanjing Friendship Plastic Surgery Hospital, Nanjing Medical University, Nanjing, China
JAMA Facial Plast Surg. 2013;15(5):362-368. doi:10.1001/jamafacial.2013.1285.
Text Size: A A A
Published online

Importance  Septal extension graft is an effective procedure in tip plasty because it can provide stable structural support for the nasal tip. However, in Asian patients septal cartilage is much weaker, thinner, and smaller than that of white people, causing the existing caudal septal cartilage and the septal extension graft to deviate to the opposite side of graft placement.

Objective  To introduce an effective and reliable modified septal extension graft in tip plasty.

Design, Setting, and Participants  Observational study of a total of 143 patients (84 undergoing primary rhinoplasty and 59 undergoing secondary rhinoplasty).

Intervention  A modified septal extension graft technique in combination with other procedures, including tip graft and implant augmentation.

Main Outcome and Measure  Subjective evaluation based on photographic analysis.

Results  This procedure was applied in 143 Asian patients, with substantial improvement seen in the nasal tip of all patients except for 3 (1 for the overprojected nasal tip and 2 for bending of existing caudal septum). Other complications included infection in 1 patient and implant deviation in 1 patient; the implant and grafts were removed 10 days after surgery in the patient with infection. The other patient underwent revision 3 months after surgery for the deviated implant.

Conclusions and Relevance  This technique is an effective method to provide long-term, stable nasal tip support. It helps to set the existing caudal septum and the septal extension grafts exactly at the anterior midline and decrease the deviation of the nasal tip.

Level of Evidence  4.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Figures

Place holder to copy figure label and caption
Figure 1.
Triangle Septal Extension and Stripped Grafts

A, The triangle septal extension graft was placed on one side of the L-shaped existing septum. B, The stripped graft was placed on the other side of the L-shaped existing septum. Both grafts have almost the same dorsal length and dorsal border. C, Cephalic ends of both grafts were near the middle junction of the dorsal septum and upper lateral cartilages. The cephalic ends of both grafts must be fixed with the dorsal septum and upper lateral cartilages together to stabilize both grafts and the L-shaped existing septal cartilage.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Septal Cartilage Graft

A and B, The septal cartilage was cut into 2 pieces of cartilage that were used for septal extension grafts. C and D, The septal cartilage was cut into 3 pieces of cartilage, and 2 pieces of cartilages were used for septal extension graft and 1 piece for the tip graft. The septal cartilage was smaller and was used as a triangle septal extension graft. E, Two pieces of conchal cartilage were harvested: 1 for stripped septal extension graft and 1 for the tip graft.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Triangle and Stripped Septal Extension Grafts

A, Triangle septal extension graft. B, Stripped septal extension graft. C, Both septal extension grafts from the front view.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.
A 27-Year-Old Girl Who Underwent Rhinoplasty With Modified Septal Extension Graft, Implant Augmentation, and Tip Graft

A-D, Preoperative views. E-H, Postoperative views at 21 months.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 5.
A 25-Year-Old Girl Who Underwent Secondary Rhinoplasty, Including Replacement of Implant, Modified Septal Extension Graft, and Tip Graft

A-D, Preoperative views. E-H, Postoperative views at 12 months.

Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
Jobs
brightcove.createExperiences();