Septal extension graft.
When the T-graft is placed more caudally in relation to the caudal
margin of the septum, it behaves like a septal extension graft (Figure
3). For example, to correct the short nasal septum. This position can
also be used in the over-rotated nasal tip. Downward rotation can be
achieved when the domes are suture fixated to the strut part of the
T-graft. Due to the spreader-like extension the T-graft is more stable
compared to an end-to-end septal extension or with the use of extended
spreader grafts.
After fixation of the T-graft, the next surgical step is fixation of the
lower lateral cartilages to the T-graft with two or three 5/0 or 6/0
tongue-in-groove (TIG) sutures [3]. Depending on the position of
these sutures the surgeon can very precisely control the nasolabial
angle and columellar double break. The strut component of the T-graft
can extent in-between the domes for maximal tip support (thick skin) or
as a spacer between the domes to provide an adequate amount of volume in
patients with a pinched nasal tip. Alternatively the strut part can
trimmed 2-3 mm below the final position of the tip defining points for a
softer appearance of the nasal tip.