Secondary Logo

Institutional members access full text with Ovid®

Share this article on:

Modified Direct-Type Septal Extension Grafts: Their Stability and Usefulness in Asian Rhinoplasty

Han, So-Eun MD; Han, Kihwan MD, PhD; Choi, Jaehoon MD; Yun, Tae Bin MD

doi: 10.1097/SAP.0000000000000880
Aesthetic Surgery

Background In Asian rhinoplasty, many autogenous cartilage grafts are required for correction of the nasal tip and columella, but the amount has limitations. A modified direct-type septal extension graft, in continuity with the entire caudal border of the septal cartilage with an edge-to-edge coaptation, can effectively and concomitantly correct the nasal tip and columella deformities using a limited amount of septal cartilage graft. The purpose of this study was to evaluate long-term cosmetic outcomes and stability from the modified direct extension grafts.

Methods Fifty-seven patients with a follow-up of more than 1 year were enrolled in the study. A total of 11 measurement items were evaluated from basal and right lateral views by photogrammetry using standardized clinical photographic techniques.

Results The overall mean follow-up period was 20.4 months. When comparing the preoperative and postoperative values, the nasal tip projection, nasal bridge length, nasal tip angle, height of nose, and the columellar labial angle increased significantly; additionally, the soft nose width index, width between ac-ac index, nostril axis inclination, columellar length (Rt-Lt), and the alar length (Rt-Lt) decreased significantly. No resorption, buckling, or displacement of the graft was observed during the follow-up period.

Conclusions The modified direct extension graft demonstrated a marked aesthetic improvement in the nasal tip and columella, and it provided long-term stability. Therefore, the modified direct extension graft is useful for correction of the nasal tip and columella in Asian rhinoplasty.

From the *Department of Plastic and Reconstructive Surgery, Ilsan Paik Hospital, Inje University, Goyang; and †Department of Plastic and Reconstructive Surgery, Keimyung University School of Medicine, Daegu, Republic of Korea.

Received April 1, 2016, and accepted for publication, after revision June 22, 2016.

Kihwan Han and Jaehoon Choi contributed equally to this article as corresponding authors.

Conflicts of interest and source of funding: none declared.

Reprints: Jaehoon Choi, MD, Department of Plastic and Reconstructive Surgery, Keimyung University School of Medicine, Dalseong-ro, Jung-gu, Daegu, 700-712, Republic of Korea. E-mail:

Supplemental digital content is available for this article. Direct URL citations appears in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.