The importance of one of the most difficult types of Rhinoplasty may very well be depicted by the phrase ‘As goes the septum, so goes the nose’. Yeap! You got that right, it’s septal extension graft (accompanied with derotation graft).
There is nothing more challenging than correcting a nose that robs the face off its proportion. While few of you would be looking forward to learning about the magic bullet that would assuage all nose-related concerns, I am certain that some would still be wondering, “Do I have that nose?” Well, read on, ask these questions and see if this is the right procedure!
Do I have a Short Nose?
Ideally, length of our nose is one-third of the length of our face and anything less than that is bound to create a disproportionate look. Also, a nose too short has more than usually visible nostrils on front view (hence the term up-turned), mostly because the nasolabial angle exceeds the normal range (95-105).
Am I an Ideal Candidate?
Lengthening procedure has also been found to be a better fix for people who have:
- Short nose due to a previous surgery
- Severely retracted columella
- Loss of anterior cartilage so much so that the tip is supported poorly
- Over resection at the end of nasal septum leading to ‘pig’s nose or snout nose’ or in simple words an overly-rotated nose (upturned nose)
The most common procedure for a short nose and overly exposed nostrils
- Repositioning of Alar Cartilages- This extends the length of the nose by simply repositioning alar cartilages using a special suture
- Septal extension graft lengthens the nose with the use of the following cartilages;
- Septal nasal cartilage
- Rib cartilage
- Costal cartilage
- Donated costal cartilage
- Lengthening nose with ear cartilages- This step involves implantation of conchal cartilages (Ear Cartilage) to lengthen the alar cartilages.
- Derotation graft : De rotation graft is another way of maintaining the extended and fixed alar cartilages. This makes use of conchal (ear cartilages) acting as a buffer between alar cartilage and the septum resulting in a lesser rigid nasal tip and a more elongated nasal tip.
- Hybrid septal graft– makes use of a combination of both the above types of cartilages.
How are Septal Extension Graft and Derotation graft carried out?
Little short of a wonder, septal extension and de rotation grafts are miraculous techniques for East Asians that have gained immense popularity in Korea. They serve to be of great use for Asians since they have relatively thick skins and weak lower lateral cartilage.
Placing a septal extension graft needs a sufficiently long and wide piece of septal cartilage. At times there isn’t sufficient harvestable septal cartilage due to individual physical characteristics or previous surgeries and this is when autologous costal cartilage, or conchal cartilage (Ear Cartilage) or a foreign material can be used.
Advantages and Disadvantages
While we zero in on the benefits and drawbacks of the surgeries, one factor that single-handedly determines the success of the procedure is the choice of the surgeon. A board certified experienced surgeon, skilled enough to deal with revision Rhinoplasty should ideally be chosen.
Coming back to the advantages and disadvantages that are a part and parcel of surgeries, let us throw some light on the shortcomings of septal extension graft, since its wonders have already been discussed.
- An uncomfortably rigid nasal tip due to fixing of medial crus of alar cartilages to a septal extension graft
- Under correction of short nose is a shortcoming specific to East Asians due to a small and weak septal cartilage
- In individuals with a history of septal extension graft, septal cartilage is limited and rib cartilage needs to be used leaving a chest scar
- There is gathering of lateral crus of alar cartilage at times leading to a pinched tip and alar retraction.
While septal extension graft is the preferred method for tip lengthening and maintaining tip projection and rotation, it does have its limitations. There is often an unnatural appearance and rigidity of nasal tip observed in individuals who have undergone the procedure and to overcome this and a couple of more short comings, derotation graft is carried out. And all these drawbacks are taken care of. Derotation graft offers;
- Short nose correction
- Less post-operative nasal rigidity
We, at JW Plastic Surgery Center Korea have such skilled and experienced surgeons who not only focus on the surgical techniques, but counsel the individuals and help them set realistic expectations so that they’re more satisfied with the final outcome. We make sure; we meet the Korean Plastic Surgery standards that make South Korea the global plastic surgery capital.