Many patients undergoing open septorhinoplasty want to keep their nasal tip characteristics, and the surgeon's task is to meet this expectation and provide stable long-term results. Techniques used to reconstruct nasal tip support include the tongue-in-groove, caudal septal extension graft, and caudal septal replacement graft procedures.
This illustration from "Preserving Nasal Tip Rotation and Projection in Open Septorhinoplasty" (doi: 10.31486/toj.22.0006) shows the tongue-in-groove technique in lateral view with medial footplates sutured to the caudal edge of the septum.
The caudal septal extension graft is demonstrated in lateral view with extended spreader graft (orange) and caudal septal extension graft (pink) with medial footplates sutured to the caudal septal extension graft.
The caudal septal replacement graft is demonstrated in lateral view with caudal septal replacement graft (pink) sutured to the nasal spine and dorsal septum/extended spreader graft (degree of dorsal septal removal varies based on the extent of deviation). (Graphic by Barbara Siede, Ochsner Clinic Foundation)