The Slice Extension Graft: A Cartilage-Preserving Modification of the Septal Extension Graft

INTRODUCTION: Septal extension grafts (SEGs) are widely used in structural rhinoplasty to provide stable control of nasal tip projection and rotation. However, conventional fixation methods may increase cartilage consumption, intranasal bulk, and the potential for asymmetry. The Slice Extension (SE) graft was developed as a cartilage-preserving modification of the SEG that maintains graft continuity while creating an embracing fixation pattern around the caudal septum. OBJECTIVE AND HYPOTHESIS: To describe the SE graft and evaluate its clinical performance in a case series of patients undergoing rhinoplasty. We hypothesized that the SE graft would provide stable nasal tip support while preserving cartilage length and maintaining graft centralization. STUDY DESIGN: Retrospective case series. METHODS: Forty-one patients undergoing primary or secondary rhinoplasty with the SE graft between 2023 and 2026 were included. Minimum follow-up was 12 months. Demographic data, postoperative complications, revision procedures, and patient-reported satisfaction were reviewed. Outcomes included tip deviation, overrotation, nostril asymmetry, nasal obstruction, infection, and fixation-related instability. RESULTS: Forty-one patients were included in the study, comprising 18 male and 23 female patients. Mean age was 31.3 ± 8.8 years (range, 18-53 years). At 12-month follow-up, 36 patients (87.8%) reported satisfaction with nasal tip appearance and support. Revision surgery related to nasal tip appearance was required in two patients (4.8%), including one minor and one major revision procedure. Postoperative complications were infrequent. No cases demonstrated clinically significant fixation failure or loss of nasal tip support during the follow-up period. CONCLUSIONS: The Slice Extension graft provided predictable control of nasal tip projection and rotation with acceptable complication and revision rates. By preserving graft continuity and minimizing cartilage loss for fixation, the technique may offer a reproducible alternative to conventional SEG fixation in selected patients.