Are Caudal Septal Extension Grafts Always Required to Derotate a Nasal Tip?

I had septorhinoplasty 5 years ago and my tip is slightly overrotated and have nasal valve collapse. One of the revision specilists I have seen said that rib cartilage is neeeded to create a caudal septal extension graft in order to derotate the tip. Other specilists said that this is not necessary and the derotation can be done without it (although ear cartilage will be used to fix other problems).So I am wondering if caudal septal extension grafts are always required to derotate a nasal tip?

Doctor Answers 7

Counter-Rotation of the Nose

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There are usually at least several techniques to achieve similar types of effect  when performing rhinoplasty and revision rhinoplasty.  Caudal extension grafts can be used to lengthen the nose and in some instances to counter rotate the nose. This just depends on the size and configuration of the graft.  There are other techniques that can counter rotate the nose as well. Revision rhinoplasty is like a puzzle in the sense that the surgeon must pick the best combination of techniques/maneuvers that together will achieve the best possible results.

It is always smart to seek several opinons, as you are doing.  Choose a surgeon that is proficient in revision rhinoplasty and you feel most comfortable with as well.

Boca Raton Facial Plastic Surgeon
5.0 out of 5 stars 68 reviews

Many options exist for lengthening a short nose

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Although septal extension grafts (SEG) are one of the better options for lengthening the nose, many other options exist and the the best method depends on careful analysis of your nose.

De-Rotating Nasal Tip

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A caudal septal extension graft is not always necessary to de-rotate the nasal tip. Depending on your prticular needs, other techniques, including some much easier, can be used.  Cartilage grafts are usually necessary to correct valve collapse.  

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 40 reviews

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Revision rhinoplasty, rotating the tip back down

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A caudal extension graft is very helpful in revision of a nose which has been rotated too high, and yes, they are not always needed. There are other tools which can be used depending on the position and natural support of the tip. The caudal extension graft in many forms is a proven one and rib grafts are not the only source. Perhaps this is the sticking point. We are not fond of rib grafts, however a caudal extension graft is a winner.

Best of luck,


De-Rotate the Tip with cartilage Grafts

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To fix your nasal valve collapse you would require cartilage grafts (either spreader or butterfly) . However, depending on what is causing your tip rotation, cartilage grafts may or may not be required.



Caudal septal extension graft and tip derotation

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Caudal septal extension grafts aren't always required to derotation the nasal tip. A lot depends on what is going on with your nose exactly.

Tip rotation can be difficult to achieve so a caudal septal extension graft is often a good way to create a more durable result. In many cases the tip has a tendency to want to rotate up again with time as the nose heals and scar contracture takes hold.

Rather than the specific technique used, what really matters is that the end result is what you want (and that it is durable). It's important to discuss with your potential surgeons how likely their method will be successful. Also, review before and after photos of similar patients -- make sure that the after photos are at least 1 year postoperative.


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Tip rotation is a very difficult problem and can be achieved by several methods.(therefore there is no good sure method). Caudal septal graft, Intercrural graft, and sutures are all methods to rotate the tip. Find an expert to explain his/her method and expected success. Interview several rhinoplasty surgeons.

Samir Shureih, MD
Baltimore Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.