“Septal T”: A Spacer and Conformer for Properly Contoured Nasal Tip in Rhinoplasty

Achieving an aesthetically pleasing and structurally stable nasal tip is complex. Often than not, such procedures are performed through an open approach that brings into play a vast array of maneuvers and techniques.

This week, IFAAS faculty, Dr. Enrico Robotti, shares his exclusive techniques of using the "Septal T" as a Spacer and Conformer for Properly Contoured Nasal Tip in Rhinoplasty.

Nose Tip Configuration

An ideal nose tip configuration resembles a gently opened diamond and it is important to note that the shape of the nose tip depends primarily on the appropriate suturing maneuvers, followed secondarily by the infralobular contour, before it can be finalised through the use of the “Septal T” onlay graft.

"Septal T"

The term “Septal T” is self-defining; referring to the T-shaped dorsal portion of the septum, which includes both a vertical portion of the septum in one single unit and two transverse limbs that are in effect pertinent to the septum, flowing laterally into each upper lateral cartilage.

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The “Septal T” portion is usually obtained after component separation and incremental reduction of the dorsum, and has been found to be ideally suited for the following indications:

Stabilizing the appropriate domal and medial crura architecture
Controlling the intercrural width (by contouring the graft)
Providing final tip finesse onlay grafting and camouflage

Contouring Nasal Tip using “Septal T”

If a performing surgeon is careful to excise the segment in one unit and not in piecemeal, utilizing the “Septal T” can be an ideal solution because of the following advantages:

1. The intrinsic shape of the septal “T” simulates an “anatomic” graft as a combination between a shield and infralobular graft with the intercrural width being controlled by contouring the graft (as shown above).

2. The “Septal T” graft can be accurately sutured between both medial crura, fitting nicely in the V-shaped infralobular midline “cleft”. In some cases, mild crushing may help soften the very distal segment at the nasolabial angle.

3. The consistency of the “Septal T” is ideal, thus, the segment will be soft and moldable; hence holding the sutures well.

4. It does not matter very much whether a strut or tongue-in-groove septal extension graft is utilized to position and stabilize the tip, because the “Septal T” will serve as a spacer and a shaper, rather than an element of support.

Results

While the “Septal T” technique may not be suitable in all circumstances, it has the ability to deliver remarkable results in patients when used correctly as it can potentially produce a soft and uniform contour in the infralobular portion of the nasal tip.

Resources:

https://academic.oup.com/asj/article/37/1/122/2623670

Learn more about advanced cutting-edge techniques in Rhinoplasty by Dr. Enrico Robotti and 5 other renowned plastic surgeons in the upcoming Fresh Cadaver Hands-on Master Class in Verona, Italy:

IFAAS Mini Fellowship (Observation)

Italy - 2nd Beauty of the Face Elite Master Class - Rhinoplasty, Facial Rejuvenation, Fat Grafting

June 7-8, 2019: Verona, Italy