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Original Investigation |

Complications of Septal Extension Grafts in Asian Patients

Ji Yun Choi, MD, PhD1; Il Gyu Kang, MD, PhD2; Hedyeh Javidnia, MD3; Jonathan M. Sykes, MD3
[+] Author Affiliations
1Department of Otorhinolaryngology, Chosun University College of Medicine, Kwangju, Korea
2Department of Otorhinolaryngology, Gachon University College of Medicine, Incheon, Korea
3Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of California Davis Medical Center, Sacramento
JAMA Facial Plast Surg. 2014;16(3):169-175. doi:10.1001/jamafacial.2013.2379.
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Importance  Nasal tip-plasty is one of the most important and difficult parts of rhinoplasty. Three-dimensional positioning of the nasal tip is a vital component in the overall appearance of the tip. The use of a septal extension graft (SEG) is a versatile technique that can supply nasal tip support and aid in positioning of the tip, as well as provide projection and lengthening. However, complications with this method can occur, and the incidence of these issues has risen with the increased use of this technique.

Objective  To investigate the problems resulting from nasal tip surgical procedures using an SEG.

Design, Setting, and Participants  This study involved a retrospective review of 44 consecutive patients who underwent nasal tip-plasty using an SEG. Patient results were analyzed with medical record review, patient questionnaires, and preoperative and postoperative photographs. Anthropometric measurements and analysis were performed for the pre- and postoperative tip projection and nasolabial angle.

Main Outcomes and Measures  Prevalence of different complications of SEGs in Asian patients.

Results  Eighty-six percent of the patients who had SEGs were satisfied with the cosmetic appearance of their nasal tip. Septal cartilage was the most frequently used material for SEGs. Complications in patients who had SEGs included nasal tip stiffness (45.5%), a decrease of projection (45.5%), nasal tip deviation (11.4%), and infection (4.5%). The revision rate was 9.0%.

Conclusions and Relevance  Asian nasal tip-plasty using an SEG can result in successful outcomes, providing nasal tip support, projection, and length. However, care needs to be taken to prevent complications such as hardness, loss of projection, nasal tip deviation, and infection.

Level of Evidence  4.

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Figure 1.
Landmarks and Anthropometric Measurements

G indicates glabella; NLA, nasolabial angle (yellow lines); Sn, subnasale; TP, tip projection (white arrow). Distance between the commissure and the rabrale superius is indicated by the red line.

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Figure 2.
Preoperative and Postoperative Views of Patients With Tip Drooping

Preoperative (A) and 3-month (B) and 1-year (C) postoperative views of a 26-year-old male patient with mild to moderate tip drooping. Preoperative (D) and 3-month (E) and 1-year (F) postoperative views of a 23-year-old female patient with severe tip drooping. B and E, Three-month postoperative views: tip was projected and lengthened. C and F, One-year postoperative views: tip was deprojected compared with the 3-month postoperative view.

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Figure 3.
Infection in a 20-Year-Old Woman After Tip-Plasty Using a Septal Extension Graft

A, Preoperative view. B, One-month postoperative frontal view: tip was lengthened and projected. C, One-month postoperative basal view shows tip and columellar infection.

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Figure 4.
Preoperative, 6 Months Postoperative, and 1 Year After Revision Operation in a 26-Year-Old Male Patient With a Deviated Tip After Tip-Plasty Using a Septal Extension Graft

A and D, Preoperative views: crooked nose and deprojected tip shown. B and E, Six-month postoperative view: tip was lengthened and projected but with a deviated nose and exaggerated columellar deviation. C and F, One year after revision operation. Columellar and dorsal deviations were corrected.

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Figure 5.
Preoperative, 12 Months Postoperative, and 6 Months After Revision Operation in a 21-Year-Old Female Patient With Tip-Plasty Using a Septal Extension Graft

A and D, Preoperative views. B and E, Twelve-month postoperative views: tip was projected and lengthened, but the patient believed her nose looked too long. C and F, Postoperative views 6 months after the revision operation: nasolabial angle was increased.

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