Caudal Septal Extension Graft in Combination with Spreader Flaps and Extended Spreader Grafts: An Alternative Technique for Lengthening a Short Caucasian Nose-A Case Series.

backgroundLengthening a short nose using costal cartilage is common in primary and revision rhinoplasty but has drawbacks, including complexity, two surgical sites, and high complication rates. We present an alternative technique using only septal cartilage to avoid these disadvantages and report our outcomes.

methodsWe analyzed 36 Caucasian patients who underwent primary rhinoplasty for short nose deformity between January 2019 and December 2022. Patients with sufficient nasal projection (> 30 mm men, > 27 mm women) were selected. Nasal elongation was achieved via an open rhinoplasty approach using autologous septal cartilage grafts. Spreader flaps, in combination with extended spreader grafts and a septal extension graft, were employed to lengthen the nose. Aesthetic outcomes were evaluated through anthropometric measurements, including nasion to tip-defining point (N-TDP) and nasal tip projection (NTP), as well as assessments of patient and physician satisfaction.

resultsMedian follow-up was 13 months (7-26 months). N-TDP increased by 4.1% (p < 0.001). NTP decreased from 30.2 to 27.2 mm (p < 0.001), achieving the aesthetic objective. Both patients and physicians reported high satisfaction, with no serious complications observed.

conclusionEnd-to-end septal extension grafting, combined with extended spreader grafts and spreader flaps, is effective for lengthening a short nose in Caucasian patients with sufficient nasal projection. The main contribution of our approach lies in its practical applicability avoiding the potential risks associated with the use of costal cartilage while achieving stable projection and lengthening through the exclusive use of septal structures. The availability of septal cartilage and the condition of the mucosa and skin remain key challenges. Surgical outcomes: In this cohort study of 36 Caucasian patients, nasal length (N-TDP) increased by 4.1% (p < 0.001), and nasal tip projection (NTP) decreased from 30.2 to 27.2 mm (p < 0.001), achieving aesthetic goals with high patient and physician satisfaction. CLINICAL IMPLICATIONS: End-to-end septal extension grafting, combined with extended spreader grafts and spreader flaps, is effective for short nose lengthening in Caucasian patients with sufficient nasal projection, though septal cartilage availability and mucosa/skin condition remain challenges. Alternative Technique: With this novel technique, we can use only autologous septal cartilage instead of costal cartilage, avoiding the disadvantages of complexity, multiple surgical sites, and high complication rates in short nose lengthening in Caucasian patients with sufficient projection. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .