"Touching the nose in the growth period stops the face from growing"—to this anxiety, a California laboratory half a century ago had given one answer[1]. To state the conclusion first:if you choose the way of cutting, the facial development is at a level indistinguishable to the naked eye. However, there are conditions.
The most common question in consultations is this:
"If I have surgery on the septum (the partition inside the nose) in the growth period, won't my face become distorted in the future?"
What those who searched "I want a septal extension in middle/high school" are concerned about ultimately converges here. A 1973 puppy experiment gave a certain direction to this question.
What people who search for middle/high school septal extension are really anxious about
Conclusion: Although the search terms differ, the worry deep down comes down to the single point of"is it all right to surgically operate on a nose that hasn't finished growing."
The search term "middle/high school septal extension" is a phrase that tends to take on a life of its own online. Eighty percent of those who voice the same anxiety in the consultation setting are torn over one of the following.
- Is it all right to treat a child's nasal congestion surgically
- If I have rhinoplasty in my late teens, won't the contour of my face collapse
- Won't the scar that forms after surgery raise up and remain
- I want to refine the volume insufficiency around the nose, but won't it affect growth
The axis of this column is the pilot study of canine pups that Bernstein published in 1973[1]. It is an experiment that cut out the septal cartilage of puppies 4–6 weeks old and tracked them for over 10 months. Although it is old, studies that deal head-on withgrowth-period nose surgery and facial developmentare still not many today.
In addition, for those concerned about scars, we also touch, within the relevant scope, on the surgical treatment of keloids[3]and fat transplantation, which becomes a topic in volume adjustment around the nose[2].
What you who searched "I want a septal extension in middle/high school" will grasp in the next 5 minutes isthe safety margin of growth-period nose surgeryshown by puppy data half a century ago. The following chapters trace it from its experimental design.
The stage of the experiment: a 2.5 kg mixed-breed puppy, a microscope, and the quadrilateral cartilage
Conclusion: To simulate surgery on human children, it is an experiment that usedmixed-breed puppies 4–6 weeks old and weighing 2.0–2.5 kg[1].
Bernstein tried to carefully trace, with an animal model, what would happen if an "orderly submucous resection (a technique that leaves the mucosa and extracts only the cartilage)" were performed on a child[1]. Why puppies? Because their physique, growth rate, and cartilage size are easy to match to the conditions of nose surgery on human children.
The technique is "done with the necessary minimum"
The procedure was simple.
- Dorsal midline incision (cutting vertically down the middle of the nose)[1]
- Hemostasis of the subcutis by electrocoagulation[1]
- Exposing the upper lateral cartilage (corresponding to the human lateral nasal cartilage) and operating under a surgical microscope[1]
- Excising only the targeted part of the quadrilateral cartilage (the cartilage forming the center of the septum)[1]
As a point taken further,barely peeling the mucoperichondrium (the thin membrane wrapping the cartilage) on the opposite sidewas thoroughly carried out[1]. Peeling only the necessary amount and extracting only the targeted cartilage. This carefulness influenced the later conclusion.
The cut positions were recorded "divided into 4"
Dividing the septum into 4 quadrants—dorsal, ventral, anterior, and posterior—where and how much was taken was recorded on the puppy's cartilage outline[1].
Because no change in appearance was seen even after 10 months in the first group, Bernstein tightened the conditions. In the next 6 dogs, he switched to a more aggressive experiment ofexcising almost the entire quadrilateral cartilage[1].
How the controls were set up is quietly important. By preparing even a "surgery without cutting," he set out to separatewhether the face becomes distorted because the cartilage was taken, or distorted merely by peeling the mucosa[1].
The point to grasp is just one—in considering middle/high school septal extension, the structure that a researcher half a century ago trackedwith controls aligned by stage of intervention.
After 10 months, the puppies' faces had grown
Conclusion: Between the puppies that underwent surgery and the control group,no distinguishable difference appeared in the dorsum or the central third of the face[1].
"If you take the cartilage, the nose should cave in." Bernstein's observation quietly betrayed that intuition.
Tracing it on the time axis goes like this
Because the inside of the puppies' noses could not be examined while awake, there was the constraint thatone could only reason backward from the appearance and the final tissue findings[1]. Even so, Bernstein matter-of-factly recorded that "signs suspecting postoperative complications did not appear in the puppies"[1].
Findings seen from outside
- No findings indicating delayed development in the dorsum or the central third of the face[1]
- No disturbance of the dental occlusion[1]
- Between surgery and euthanasia, the septal cartilage grewto nearly double in all 3 directions (vertical, horizontal, depth)[1]
Furthermore, even when the excised septum was illuminated with strong transmitted light,it was extremely difficult to identify the place where surgery had been done, it is recorded[1]. Perforation of the septum (perforation) was also zero[1].
Findings seen under the microscope
Thin sections were observed with hematoxylin and eosin staining (common tissue staining), and some with Koneff staining (a triple staining of methyl green, aniline blue, and hematoxylin, said to indicate newly formed cartilage)[1]. This staining result became the backing for the naked-eye findings.
- In all operated individuals, the growth of new cartilage was confirmed[1]
- In some, resorption of the original cartilage (absorption, the phenomenon of dissolving and disappearing) also coexisted[1]
- There were examples where the two cut ends united cartilage-to-cartilage without interposing fibrous tissue[1]
"The cut place becomes hard to find 10 months later"—the strength of this clinical implication is the core of this study. In considering the anxiety about middle/high school septal extension, it is no small piece of data.
The next chapter enters the branched experiment of autograft—what happens if you put backthe cartilage that was cut out and discarded.
Putting back the cut-out cartilage—the quiet conclusion of autograft
Conclusion: When the excised cartilage is put back in its original position as is,the graft survives and grows at almost the same pace as the surroundings[1].
Separately, in 6 dogs, Bernstein set up an experiment of once cutting out the central part of the quadrilateral cartilage and putting it back in its original position without fixing it[1]. Merely dropping the mucoperichondrium back into its original position, without suturing down the graft[1].
- The grafted cartilage took, and remained alive even to the naked eye[1]
- Although there was some early or concurrent resorption,it continued to grow at almost the same rate as the entire septum[1]
The clinical implication drawn from this is simple. When touching cartilage in growth-period nose surgery,a design of "putting back / re-assembling" rather than "extracting and discarding" can minimize the impact on development. The option of autograft has had validity in this context since half a century ago.
If you re-examine the anxiety about middle/high school septal extension from another angle, what is important isthe handling of the cartilage afterward, more than whether it was cut—this perspective can be obtained.
That said, the story does not end here. The "unexpected resorption" that occurred in the control group became another lesson for technique design.
The upset that occurred on the "non-cut side"—the lesson of the control group
Conclusion: In the control puppies in which only one side of the mucoperichondrium was peeled,the quadrilateral cartilage and the lateral cartilage were almost completely resorbed, whereas in the controls peeled on both sides the cartilage remained[1].
It is a counterintuitive result. In the 4 dogs in which the mucoperichondrium was widely peeledon only one side, without putting a scalpel to the cartilage at all, the quadrilateral cartilage and the dorsal lateral cartilages had almost entirely disappeared[1]. Even so,no externally visible facial deformity appeared[1].
In contrast,in the 2 dogs in which the mucoperichondrium was peeled on both sides,no cartilage resorption occurred, and they were indistinguishable in appearance from the other controls[1].
Why did resorption occur on only one side
While avoiding a definitive statement, Bernstein citedthe possibility that a subclinical infection (a mild infection without clear symptoms) occurred in the hematoma under the mucoperichondrium[1]. The background is that all 4 dogs were siblings from the same litter, and the externally visible postoperative course was extremely uneventful.
Drawing it to the context of middle/high school septal extension, the lesson of this reversal phenomenon is one.More than whether the cartilage is cut, the surrounding blood circulation, infection control, and handling of the perichondriuminfluence the result[1].
Cartilage is delicate, but the appearance of the face is tougher than imagined—this asymmetry also comes into play in modern rhinoplasty design.
Answering the anxiety about middle/high school septal extension with 1973 data—but with 3 caveats
Conclusion: The puppy experiment showed hope, but to extrapolate it as is to the human growth period,3 reservationsare necessary.
Those who have read this far should already see that it can no longer be discussed with the simple formula "growth period = don't touch."Most of the situations feared behind the search term "middle/high school septal extension" can be avoided if the technique is chosen—that was the implication of the 1973 data. However, please keep the following in a corner of your mind.
1. This is, after all, a story about "puppies"
Bernstein himself, at the end of the paper,clearly writes that it should be retested in a more uniform animal population, preferably in primates[1]. There is no guarantee that a difference not seen in mixed-breed puppies will not be seen in humans. For children's nose surgery, individual indication evaluation is essential before concluding "it seems safe" with the same logic.
2. The premise is "careful submucous resection"
What this experiment assumed was a simulation oforderly submucous resectionfor children, not violent cartilage destruction[1]. When other researchers performed near-total resection in rabbits or other puppies, there is the contrasting report thatthe growth of the dorsum and midface was clearly suppressed[1].
3. Postoperative "scars" are a matter of a different axis
Those with a constitution where the skin scars around the nose raise up (keloid, hypertrophic scar) need separate preparation. In Pollack and Goslen's review of keloid surgical treatment as well, not excision alone buta combination with postoperative adjuvant therapyis the premise[3]. The "nose scar" issue, searched alongside "middle/high school septal extension," is faster to judge separated from the impact on growth.
In cases where fat transplantation is considered for volume correction around the nose, as Coleman organized,selection of the donor site, prior marking in the standing position, and aseptic techniqueand other basic principles influence the result[2]. It is an item that needs to be considered in parallel with growth.
If designed after understanding the caveats, growth-period nose surgery remains as an option—that is the summary up to here.
Q&A: 5 frequently asked questions
Conclusion: The majority of anxiety can be resolved outside the dichotomy of "cut or don't cut."
Q1. If I have septoplasty as a child, will my face become distorted in the future?
In Bernstein's puppy experiment,with careful submucous resection, no macroscopic developmental disorder was confirmed[1]. The final judgment in humans depends on the combination of age, skeletal maturity, and the specific technique. It is at the stage where retesting in primates is needed[1].
Q2. If a lot of cartilage is taken, won't the nose become low?
In other animal studies, the opposite result thatextensive resection suppresses developmenthas also appeared[1]. The amount of resection and the technique design divide the result.
Q3. Is a "non-cutting" surgery safe?
In Bernstein's control group, there areexamples where the cartilage was resorbed merely by peeling the mucoperichondrium[1]. The simplification of not cutting = safe is scientifically crude.
Q4. I'm afraid the postoperative scar will become a keloid
For those with a keloid constitution, a strategy of combining not only simple excision but alsolocal steroid injection, compression therapy, skin grafting, and so onis organized in the literature[3]. It is a domain to design after evaluating the constitutional risk in advance.
Q5. Can fat transplantation be used for volume correction around the nose?
There are basic principles such as selection of the donor site, marking in the standing position, and aseptic technique[2]. The indication for growth-period humans is within the range judged individually in a consultation.
If a question that concerns you remains, please go to the next chapter.
If you find yourself thinking, "What about my case?"
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Summary—you who have read this far are already outside "vague anxiety"
Conclusion: The anxiety tied to the search term "middle/high school septal extension" can, if you raise the resolution with correct information, be broken down into3 concrete judgment points.
To review, it goes like this.
- In the puppy experiment,with careful submucous resection, no macroscopic difference appeared in facial development[1]
- The autograft ofputting the cut-out cartilage back in its original positiontook, and growth also continued[1]
- The handling of the mucoperichondrium, blood circulation, and infection management influence the fate of the cartilage[1]
- The final conclusion in humans requires further verification, including in primates[1]
- Scars and volume correction are a domain of measures on a different axis[2,3]
The rest is just whether it applies to your case. Age, the maturity of the bone structure, whether the nasal concern is functional (breathing) or aesthetic, whether scars tend to raise up constitutionally—these cannot be decided in an article.
Many of the questions you arrived at via the search term "middle/high school septal extension" can be sorted out in a 15-minute face-to-face consultation.It is not a place to forcibly recommend a procedure. It is fine just to come, listen, and go home. The consultation is free.
If you have any concerns, please feel free to consult us. According to each person's situation, we will separate the necessary information from the unnecessary information and tell you.
References
- Bernstein L.. Early Submucous Resection of Nasal Septal Cartilage: A Pilot Study in Canine Pups. Archives of Otolaryngology - Head and Neck Surgery. 1973 https://doi.org/10.1001/archotol.1973.00780010281012
- Coleman William P.. FAT TRANSPLANTATION. Dermatologic Clinics. 1999 https://doi.org/10.1016/s0733-8635(05)70136-4
- POLLACK SHELDON V., GOSLEN J. BLAKE. The Surgical Treatment of Keloids. The Journal of Dermatologic Surgery and Oncology. 1982 https://doi.org/10.1111/j.1524-4725.1982.tb01092.x