Septorhinoplasty Using Septal L-Strut Extension Graft: A Long-Term Multi-Dimensional 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 by a heavy alloplastic implant on the nasal dorsum. If the anterior projection of the cartilaginous dorsum can be solved 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 2012 and December 2022, a total of 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 two- and three-dimensional patient photographs. For the control arm, we also performed anthropometric analyses in patients who underwent nasal tip projection using 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 for a long-term in the SLEG group. In the control group, tip projection were achieved immediately but decreased over time compared to the SLEG group.

Conclusions: The present study demonstrated that the SLEG might be an effective technique to achieve a septum-dependent lower two-thirds of the nasal dorsum advancement and tip projection for a long-term.