Where is it easy to stumble with septal extension rhinoplasty? What to ask before surgery

It is easier to stumble over nasal airflow rather than the appearance of the nasal tip. Septal deviation following septal extension is listed first among the causes of postoperative nasal obstruction requiring surgery[1]. Because aesthetic dissatisfaction and functional problems occur separately, it is reassuring to hear explanations about both before surgery.

Why does nasal obstruction occur?

It can happen because the septum used as the base itself becomes deviated. Among the causes of postoperative nasal obstruction that require surgical intervention, septal deviation following septal extension, excessive thinning of the nasal bones, medial displacement of the inferior turbinate, nasal valve collapse or stenosis, and septal valve scarring are listed.[1].

Nasal obstruction for a period after surgery is due to mucosal edema and naturally subsides. When it does not subside and persists, the causes listed above are suspected.[1]. A randomized trial evaluating nasal airflow support with an alternative graft (spreader graft) has been conducted to assess quality of life.[2].

What is involved in transplanted cartilage movement?

Differences in fixation methods are being studied. There is research comparing polypropylene sutures and polydioxanone sutures for how to fixate the graft in septal extension.[3]. Which suture is used is a choice that leads to stability of the transplanted cartilage and risk of positional displacement.[3].

Attempts to quantitatively evaluate asymmetry are also progressing. There are reports measuring the symmetry of the nasal ala base, nasal airway, and nasal tip projection numerically.[4]. However, this is research targeting nasal deformity from cleft lip, and cannot be directly applied to general septal extension rhinoplasty.[4].

How much should I expect regarding scars and swelling?

It is more realistic to prepare on the premise of using the external incision method. As drawbacks of external incision rhinoplasty, scars remaining outside the columella, extended operative time, prolonged swelling at the nasal tip, and the possibility of columellar incision separation are listed.[5].

Since septal extension rhinoplasty is a procedure to create a structure supporting the nasal tip, it is often performed using this method. While prolonged swelling is not in itself a failure, if you do not decide when to assess the shape, you may become anxious watching the progress.[5].

What changes if someone has had previous nasal surgery?

The conditions become one step more difficult. Patients who previously had an implant placed tend to develop complex nasal deformity, require correction over a wider area, and have higher risk of secondary revision surgery.[6].

Secondary rhinoplasty corrects deformity or complications from previous surgery and often requires cartilage grafting to support structure.[7]. Rhinoplasty has a long learning curve and is technically challenging surgery, with a wide range of pitfalls from mild to severe affecting both function and appearance.[8].

When should revision be decided?

The premise is to wait until swelling resolves and tissues stabilize. Within the scope of this research, we did not find studies presenting revision rates specific to septal extension rhinoplasty as a number. If you encounter an explanation saying "X% require revision surgery," ask what the basis is.

Because there are no numbers, deciding the timing of judgment before surgery becomes helpful. Please share in advance when the shape will be evaluated and when nasal obstruction should prompt consultation if it persists for several months.[1].

What to ask before surgery

The first is where the cartilage will be harvested from and whether it will be placed on one side or both sides.[3]. The second is a guideline for how long nasal obstruction should persist before consulting.[1]. The third is when to place the timing of shape assessment.[5]. The fourth is to communicate any previous nasal surgery or implant experience, and how the plan will change.[6].

The original shape of the nose, the amount and strength of cartilage, and skin thickness vary from person to person. The information listed here is a general summary of reported findings and does not predict what will happen with your nose. At examination, have the septum's condition actually assessed, and confirm with your doctor whether the plan prioritizes nasal airflow or nasal tip appearance.