The L-Shaped Septocolumellar Extension Graft: Dorsal and Nasal Tip Stabilization in Septorhinoplasty

Abstract

Achieving durable nasal tip stabilization remains a central challenge in septorhinoplasty, particularly in patients with weak cartilage support or significant dorsal septal deviation. Conventional septal extension grafts and suspension-based techniques may provide initial projection control; however, indirect load transfer and limited columellar integration can compromise long-term structural stability. This study presents the L-shaped septocolumellar extension graft, a structural graft designed to combine septal extension and columellar support within a single load-bearing unit. The graft is fashioned in an L-shaped configuration and secured through multiplanar fixation to the caudal septum, the spreader graft–septal junction, and the medial crura, creating a continuous septocolumellar support column. Forty-eight primary septorhinoplasty patients with significant dorsal septal deviation underwent L-shaped septocolumellar extension graft placement. Clinical outcomes were assessed through postoperative evaluation of nasal tip projection, rotation, and midline alignment. All procedures were completed successfully without major intraoperative or early postoperative complications. Stable preservation of tip projection and rotation was observed during follow-up, and no revision surgery was required. The L-shaped septocolumellar extension graft technique provides integrated dorsal and tip stabilization through direct structural continuity and balanced load distribution. This approach may offer predictable and durable nasal tip control compared with conventional grafting strategies.