Who is a good candidate for Septal Extension? Understanding suitability and contraindications

Septal Extension is suited for people with a low or short nose who need the power to project the nasal tip forward or change its angle. However, depending on the amount of cartilage, skin thickness, and previous surgical history, the same structural foundation may not be able to address all cases. We will organize the specific points that determine suitability and unsuitability.

What is this surgery for in the first place?

A surgery that uses the cartilage of the wall inside the nose (nasal septum) as a foundation to create the power to project the nasal tip forward or change its angle. For round nasal tips, short nasal columns, and short noses accompanied by flared nostrils, it is positioned as the representative method for projecting the nasal tip forward[1].

Suited for those who want to create strong nasal tip projection

When there is a large gap in the cartilage and a substantial increase in nasal tip projection is needed, a square-shaped graft extending beyond the anterior angle is reportedly used[2]. Long-term outcome comparisons in reviews position it as a structural graft for controlling nasal tip projection and angle[3].

If cartilage is insufficient, it may still be manageable

When the nasal septal cartilage alone is not enough, combining a method using cartilage and bone together (SCBC) has been reported to allow management. There are also reports that the thickness and fragility of cartilage can be predicted preoperatively on CT imaging, suggesting an approach that assesses not just the "quantity" but also the "quality" of cartilage[4].

Even in cases of very limited cartilage, hybrid-type grafts have been reported to achieve nasal extension and nasal tip projection[5], but this makes the precision of planning all the more important.

Thick-skin types involve trade-offs

In thick-skin types, stronger graft cartilage is needed to achieve distinct definition, but that strength can inadvertently stiffen the nasal tip, as has been noted[6]. There are cases where firm support and natural feel when touched are difficult to achieve simultaneously.

Revision cases with hardened skin or tissue require careful judgment

As in secondary cleft lip and palate surgery, when skin or tissue has become hardened from previous surgery, adequate nasal tip projection may not be achieved with Septal Extension alone, as has been reported. In such cases, an approach has been proposed that reconsiders not just the graft but the allocation of skin itself[7].

Similarly, in nasal deformity associated with cleft lip and palate, while there are reports of successfully improving the nasal tip angle to normal range[8], the state of the underlying tissue differs significantly between unilateral and bilateral cases, and between primary and revision surgery[9].

Points to confirm during consultation

The first is how much cartilage remains in the nasal septum and what its quality is[4]. The second is the skin thickness and whether you prioritize firmness or naturalness[6]. The third is whether skin or tissue has become hardened from previous surgery[7]. Since cartilage quantity and skin condition vary greatly from person to person, the final determination of suitability can only be made through an actual consultation.