A Comparative Study Between the Modified Septal Extension Graft Based on the L-Strut Septum and the Costal Cartilage Graft Based on an Intact Native Septum in Nasal Plasty

Short-nose deformity, which is common among East Asian patients and is characterized by shortened nasal length, reduced tip projection, and tip overrotation, is technically demanding to correct because of a thick soft tissue envelope and limited, mechanically weak septal cartilage. We compared a modified L-strut-based septal extension graft construct with a costal cartilage graft based on an intact native septum in a retrospective cohort of women undergoing primary short-nose rhinoplasty (n = 48; 26 versus 22; median age, 29y versus 31 y). All procedures were performed using an open rhinoplasty approach. Three-dimensional photogrammetry quantified nasal length, tip projection, and tip rotation at baseline and at a mean of 12.6 months postoperatively. Tip support was assessed using a digital force gauge, recording the force required to depress the tip by 1 to 5 mm. Both techniques produced increases in nasal length and tip projection through 12 months (nasal length: +4.22 versus +4.42 mm; nasal tip projection: +3.43 versus +3.29 mm) and achieved caudal tip rotation (modified columellar orientation angle: -5.56 versus -7.76 degrees). Mechanical testing showed increased tip resistance in both cohorts; costal cartilage reconstruction yielded higher absolute resistance (eg, 1-mm deflection: 0.15→0.40 N versus 0.19→0.74 N; 2-mm deflection: 0.34→0.82 versus 0.41→1.34 N), whereas the modified construct increased support while preserving greater tip compliance. No major complications were observed, and patient-reported satisfaction improved in both groups. These findings support an individualized structural strategy: costal cartilage reconstruction maximizes rigidity when greater stiffness is desired, whereas the modified L-strut construct enhances support while better preserving tip compliance and avoiding an overly rigid tip.