Invited Discussion on: Bilateral Fan-Shaped Septal Extension Grafts in East Asian Rhinoplasty
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EDITOR’S INVITED COMMENTARY
Invited Discussion on: Bilateral Fan-Shaped Septal Extension Grafts in East Asian Rhinoplasty Jay W. Calvert1
Received: 24 July 2020 / Accepted: 25 July 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020
Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. This study presents a modification of the common septal extension graft [1]. The author’s modification is to create two mirror image fan-shaped costal cartilage grafts that interlock on the caudal septum. Their claim is that by creating mirror image grafts and locking them together on the caudal septum, there will be better stability over time. They opine that there will be less warping and less uncertainty over time. Thus, these characteristics should hopefully create better results in Asian rhinoplasty. One of the major strengths of this study is the number of patients. Fifty-two patients are respectable when it comes to a technical report such as this one. More would be better, but this is a series of some size and therefore, we can accept their conclusions with a bit more confidence than if there were only 5 or 10 patients. The follow-up duration is less than a year. This is helpful for the immediate issues that might occur with this technique, but a longer-term report is certainly warranted. Warping and late failures of septal extension grafts are a well-known problem in primary and secondary rhinoplasty [2, 3].
& Jay W. Calvert [email protected] 1
Beverly Hills, USA
There are several issues, though, that are not addressed here and would cause me to make recommendations of caution if a rhinoplasty surgeon would choose to incorporate this technique into their next Asian rhinoplasty. First, I would be generally concerned with the width of the columella. I do not see how the columella could not be wider given the dimensions of these grafts. This may or may not be a problem, but it is an interesting consideration for surgeons to note. Second, the stiffening of the tip of the nose is also a consideration. This factor can have a significant impact on a patient’s activities and lifestyle. The authors definitely mention this and go on to say that this was not a problem for any of their patients. With such short-term follow-up, I would recommend a longer-term follow-up on this specific point. Third, the problems that occurred with the study group the authors state were all easily handled with small revisions. Again, this is excellent, but will hopefully get a bit longer-term follow-up. The results are excellent and show that the surgeons have command of the technique. Their desire to achieve length and tip projection is achieved in both the data measurements and in the photographs. This technique thus is proven in both concept and applicat
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