Septorhinoplasty Using Septal L-Strut Extension Graft: A Long-Term Multidimensional Analysis.

[BACKGROUND] Nasal dorsal augmentation using an alloplastic implant and tip projection using a septal cartilage are generally used in Asian rhinoplasty. Excessive submucosal resection weakens septal support, causing problems due to a heavy alloplastic implant on the nasal dorsum. If the anterior projection of the cartilaginous dorsum can be resolved by cartilage grafts, the amount of dorsal onlaying can be reduced. The purpose of this study was to demonstrate the long-term stability of septal L-strut extension grafts (SLEGs) used for advancement of the lower two-thirds of the cartilaginous nasal dorsum and tip projection.

[METHODS] Between August of 2012 and December of 2022, 407 patients underwent septorhinoplasty using SLEGs. Patient outcomes were assessed by evaluating satisfaction, hardness of the nasal tip, functional Nasal Obstruction Symptom Evaluation scores, and pain scores. Anthropometric analyses were carried out with 2- and 3-dimensional photographs. For the control arm, the authors also performed anthropometric analyses in patients who underwent nasal-tip projection with other grafting techniques along with autologous dorsal onlay grafting to compare the effect of the SLEG.

[RESULTS] Anthropometric analyses demonstrated that advancement of the lower two-thirds of the nasal dorsum and tip projection were achieved and maintained long term in the SLEG group. In the control group, tip projection was achieved immediately, but decreased over time compared with the SLEG group.

[CONCLUSION] The current study demonstrated that SLEG can be an effective technique to achieve long-term septum-dependent lower two-thirds of the nasal dorsum advancement and tip projection.

[CLINICAL QUESTION/LEVEL OF EVIDENCE] Therapeutic, IV.