Correction of Short Nose Deformity Using a Septal Extension Graft Combined with a Derotation Graft

In patients having a short nose with a short septal length and/or severe columellar retraction, a septal extension graft is a good solution, as it allows the dome to move caudally and pushes down the columellar base. Fixing the medial crura of the alar cartilages to a septal extension graft leads to an uncomfortably rigid nasal tip and columella, and results in unnatural facial animation. Further, because of the relatively small and weak septal cartilage in the East Asian population, undercorrection of a short nose is not uncommon. To overcome these shortcomings, we have used the septal extension graft combined with a derotation graft. Among 113 patients who underwent the combined procedure, 82 patients had a short nose deformity alone; the remaining 31 patients had a short nose with columellar retraction. Thirty-two patients complained of nasal tip stiffness caused by a septal extension graft from previous operations. In addition to the septal extension graft, a derotation graft was used for bridging the gap between the alar cartilages and the septal extension graft for tip lengthening. Satisfactory results were obtained in 102 (90%) patients. Eleven (10%) patients required revision surgery. This combination method is a good surgical option for patients who have a short nose with small septal cartilages and do not have sufficient cartilage for tip lengthening by using a septal extension graft alone. It can also overcome the postoperative nasal tip rigidity of a septal extension graft.

Correction of the Short Nose using Derotation Graft

Among several techniques to maintain the lengthened cartilagenous tip structure, septal extension graft with septal cartilage or rib cartilage is most widely used. But in many cases, nasal tip rigidity with unnatural appearance on smiling is one of the major drawbacks of septal extension graft. The authors used a piece of elastic cartilage graft harvested form ear that can act as a cushion buffer between alar cartilage and septum instead of directly fixing the alar cartilage to extended septum for obtaining a less stiff nasal tip with sufficient nasal tip elongation. We called this graft "derotation graft". Derotation graft was performed in 1197 patients via the open nasal approach. Among them, 432(36%) patients had preoperative short nose deformity and 765(64%) patients developed intraoperative cephalic rotation of the tip resulting from procedures for tip projection such as columellar strut. Excellent results were achieved in 1110(93%) patients. 87(7%) patients had unsatisfactory results requiring a revision surgery because of overcorrection or undercorrection of tip rotation, poor tip projection and visible graft on supratip. Derotation graft is a simple, and effective procedure for short nose correction preventing with less post-operative nasal tip rigidity.