Can a septal extension graft fix collapsed nasal valve & derotate tip at the same time? (Photos)

You appear to have excessive infratip lobule projection. Sutures can help reshape this so it does not project too much. A spreader graft can help with a collapsed internal valve. The septal extension graft is not needed for these issues.

A septal extension graft can be use to support and de-rotate the tip. For internal nasal valve collapse a spreader graft can be placed between the upper lateral cartilage and nasal septum. The spreader graft can be placed to de-rotate the tip and accomplish both of your concerns.

You appear to have a pleasing nasal profile appearance, however, and you do not appear to have an overrotated chip nor a retracted columella. There are several techniques that may be used to repair a retracted Comella including an extended columella struck graft, and suturing the medial crural foot plates together. I hope this helps. Sincerely, Dr. Joseph

A septal extension graft is a great technique that can achieve many things including derotation, tip projection changes, columellar length changes, and stability of the lower nose. It does not directly help with nasal valve issues, but when correcting valve issues with techniques like lateral crural strut grafts, it is important to have a strong central support like a SEG. It's also important to note that it's not just about the chosen technique, it's how you perform it for each specific case and in the combination with other techniques. These are some of the things that make rhinoplasty, especially revisions difficult. In revision cases we also have to consider that there is scar tissue and typically a lack of good cartilage support. This requires a lot of strengthening to get the desired shape and support. Although your question is fair, it is a very small part of the big picture for your Revision. I highly recommend scheduling at least a few quality consultations to discuss the overall desired shape and potential surgical plan. You can learn a lot more and compare the plans and photos. Good luck!

Hello and thank you for your question. My preferred technique for tip derotation in a revision is full release of scar tissue and placement of extended spreader grafts. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon