Septal extension graft in "closed" revision rhinoplasty: A simplified technique

The septal extension graft (SEG) is widely used in secondary rhinoplasty for correction of a short nose with loss of tip support and projection, columellar retraction, and hyper-rotated tip secondary to an overresection of the caudal septum. Although SEG precise fixation can be relatively easy in the external approach, the difficulties of SEG placement in "closed" rhinoplasty can be discouraging.

To describe an easy surgical technique for SEG placement in endonasal revision rhinoplasty and to analyze the aesthetic results of the procedure.

Thirty-eight patients were submitted to an endonasal approach revision rhinoplasty with endonasal placement of SEG for the correction of a short nose with a hypoprojected and hyper-rotated nasal tip. Pre- and postoperative nasal length, tip projection, and tip rotation (nasolabial and lobulocolumellar angles) were measured for each patient.

An increase (mean ± standard deviation) of nasal length by 15.02 ± 3.91% and an augmentation of tip projection by 11.34 ± 2.26% were noticed after surgery with respect to preoperative conditions. A significant (p < 0.001) decrease in the columellar-labial angle was recorded on postoperative (91.23 ± 3.85°) examination with respect to preoperative (99.81 ± 6.49°) conditions. A decrease (p < 0.001) in the columellar-lobular angle was noted on postoperative assessment (34.02 ± 5.28°) with respect to preoperative examination (50.02 ± 0.36°). No relevant postoperative complication was recorded.

The "endonasal" approach described for SEG placement was an easy and reliable procedure to treat a short nose with loss of tip support and projection, columellar retraction, and hyper-rotated tip, especially in revision surgery. The advantages of our technique over previously described approaches were reported.