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Effects, downtime, risks, and precautions obtained by extending the nasal septum

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Effects, downtime, risks, and precautions obtained by extending the nasal septum

The nasal septum extension is a procedure to adjust the length and angle of the nose by inserting a thread into the nasal septum (the wall that divides the nasal hole into the left and right) or transplanting its own cartilage.

Among various nasal treatments, septal extension is said to be unsuitable for those who have a large change in appearance and want to make natural changes and who are resistant to large-scale treatments .

By understanding in advance the effects of extending the nasal septum and the risks associated with it, you can receive the treatment with peace of mind. In addition, reducing the points for selecting a clinic or doctor will lead to the expected effect.

The shape of the nose that can be expected to improve with the septum related to the shape of the nose and the extension of the septum

Septum related to the shape of the nose

Description of the nose bone The nasal septum is like a wall that divides the nose hole into left and right, and runs from between the eyes to the tip of the nose.

The height goes up to the tip of the nose, and the wall part of the tip of the nose is called the nasal column (Hanabashira) . The nasal septum is formed by three bones: the nasal septum cartilage, the vomer, and the ethmoid vertical plate, and is covered by the nasal septum mucosa.

If the nasal septum is bent, the nasal muscles will be bent, and if it is short, the nose will be a so-called pig nose with the nose hole facing up , which will greatly affect the shape of the nose .

Nose shape that can be expected to improve by extending the nasal septum

There are various problems with the nose, but there are five main types of problems that can be expected to improve by extending the nasal septum.

  • Low nose
  • The tip of the nose is pointing up
  • The tip of the nose is pointing down
  • Short nose column
  • The nose hole is wide

Features of the nose that are not suitable for septal extension

  • Eagle nose (Washibana)
  • The skin at the tip of the nose is thick and hard

* It is said that the effect can be felt by combining with nasal tip plasty.

  • Those with septal curvature (depending on the degree)
  • Those who have been treated for septal curvature

* It may be possible to extend the nasal septum by combining other treatments.

Septal extension using meltable thread

The septal extension, which uses a melting thread, is inserted from the tip of the nose along the nasal column using a special device to adjust the shape and angle of the nose . No incision is required as it is inserted through the tip of the nose.

The thread used is a medical thread that is gradually absorbed by the body over a long period of time. When it is absorbed, it produces collagen around the thread, and the collagen becomes fibrous, so even if it melts, it does not return to its original state immediately. There are various types of threads, such as those with thorns and those in the form of mesh, and the threads used differ depending on the medical institution.

Downtime is shorter than the extension of the nasal septum, which uses autologous cartilage that requires an incision, and is said to be about 2 to 7 days .

Types of melting threads used to extend the nasal septum

Thread type Material duration Construction
G-mesh PCL About 24 months The entire thread has a mesh structure like a net that protects fruits.
G-cog nose PCL About 24 months The entire thread is shaped like a wire fence
MISKO PDO 6-12 months Cogs (spike-like protrusions on the surface of the thread) are stretched in two directions, and fine fibers like brooms spread in a fan shape at both ends of the thread.
Y-KO PDO 6-12 months Cogs are stretched 360 degrees

PDO (also referred to as polydioxanone / PDS) has the property of reacting with water in the body and gradually decomposing it. The decomposed PDO is a waste product such as urine after being preyed on and digested by white blood cells called macrophages, which prey on cells and substances that are no longer needed by the body and bacteria that have invaded the body to clean the body. It is excreted from the body as.

PCL (polycarbonate lactone) is also a component of sutures mainly used in surgery. Like PDO, PCL has the property of being naturally decomposed and absorbed in the body little by little . PCL is said to have the effect of promoting the production of new collagen in the surroundings in the process of being decomposed in the body.

Septal extension using autologous cartilage

The autologous cartilage used to extend the nasal septum is collected from its own auricular cartilage, nasal septal cartilage (bichukaku nankotsu), and costal cartilage (rokunankotsu) . The collected autologous cartilage is transplanted between the ala of nose cartilage along the nasal passage to extend the septal cartilage .

When transplanting autologous cartilage, there are a closed method in which the inside of the nose hole is incised and the autologous cartilage is transplanted, and an open method in which an incision is made across the nasal column and the autologous cartilage is transplanted .

The incision is usually made through the left nasal cavity. The Killian incision is 10 to 15 mm posterior to the caudal end of the nasal septum, but the modified Killian incision is 2 to 5 mm posterior or at the cutaneous mucosal junction (Fig. 5a). The lower part of the incision line extends to the bottom of the nasal cavity. Be careful not to damage the ala cartilage above the incision line.

References: Septal Surgery-Transition of Surgery for Nasal Congestion-

Closing method that does not leave scratches on the appearance

The closed method has the advantage that it does not damage the appearance because it incises only the inside of the nose hole , but it is more difficult to balance the left and right than the open method . An incision is made from the back of the nose hole, the cartilage to be transplanted is passed through the nose hole and extended while being replenished, and fixed with a cast after the operation.

Since it is not visible, there is a risk that the transplanted cartilage will be misaligned and the tip of the nose or column of the nose will tilt . In addition, it has been reported that if the nose hole is small, it is difficult to pass through and the transplanted cartilage is broken .

Open method with a high degree of freedom in design

The open method is a method in which an incision is made in the nasal column between the inside of the nose hole and the nose to secure a wide field of view and transplant autologous cartilage .

The nasal septal cartilage into which the autologous cartilage is inserted is exposed from the incision, and the cartilage collected in advance is transplanted to the tip of the nasal septal cartilage and extended while visually observing the condition of the nasal septum and surrounding cartilage tissue. After that, the position and angle at which the ala cartilage is sewn and fixed are determined, and the nasal column is temporarily sewn while the skin is returned. Finally, adjust the balance and fix it with a cast after surgery.

It is said that the height and orientation of the tip of the nose and the desired design can be brought closer because the surgery can be performed while visually observing the surgical site.

Unlike the closing method, an incision is made up to the nasal column, which causes scars, but it is difficult to see from the front.

Types, characteristics, and collection methods of autologous cartilage used for septal extension

The autologous cartilage used to extend the nasal septum is auricular cartilage, nasal septal cartilage, and costal cartilage. Each cartilage has different collection methods and characteristics.

Auricular cartilage

Auricular cartilage can be collected from two sites. There are two methods, one is to make an incision along the wrinkle behind the ear and the other is to make a small incision in the entrance of the ear hole called the tragus and collect it from the ear canal .

It is said that the burden on the body is small because the part that does not affect the shape and function of the ear can be incised and collected.

Since the auricular cartilage is soft and lacks strength , as a general rule, two pieces are collected from both ears and used in layers . By stacking, the strength will increase, but the thickness will also increase and the nasal septum may become thicker . Also, the auricular cartilage is uneven and can stand out in the nose .

On the other hand, it is said that the auricular cartilage does not lose its suppleness even if it becomes thicker , and the tip of the nose is less likely to become stiff than other cartilage transplants .

References: Temporomandibular joint plasty combined with intermediate insertion and transplantation with auricular cartilage

Septal cartilage

The nasal septum cartilage is the hard, plate-like cartilage behind the nasal septum . When autologous cartilage is collected from the nasal septum cartilage, the cartilage is collected from the same site as the operation, so it can only be injured by surgery to extend the nasal septum .

Even if autologous cartilage is collected from the nasal septal cartilage, not all of it is collected, and it is necessary to leave the nasal septal cartilage necessary for the structure of the nose in an L shape. Therefore, there is a limit to the size that can be collected .

The dorsal nasal part of the septal cartilage, 10 to 15 mm on the caudal side, is the part that should be left to prevent saddle nose and nasal tip drop, and is called L-strut.

References: Septal Surgery-Transition of Surgery for Nasal Congestion-

If the tip of the nasal septal cartilage is far from the entrance of the nose, or if the nose is short or low, the nasal septal cartilage is originally small, so it may not be possible to collect the required size .

On the other hand, the septal cartilage is flat, thin and strong, so it is said to be easy to handle for septal extension surgery. It is said that if a sufficient size can be collected, it will not easily fall over and a thin nose can be made .

Costal cartilage

The costal cartilage is located on the thoracic part of the ribs . When collecting as autologous cartilage, an incision is made at the base of the bust for women and under the chest for men.

Since it is larger than the auricular cartilage and the nasal septal cartilage, the size that can be collected is also larger than other autologous cartilage . Therefore, it is said that even if the original nasal septum cartilage is short or small , the nasal septum can be sufficiently extended .

However, because the chest is incised during collection, scars are left on the chest as well as the scars from surgery to extend the nasal septum .

PDO plate used when autologous cartilage is insufficient

If the nasal septum extension does not have enough autologous cartilage, a medical material called a PDO plate may be used . The PDS plate is made of a substance called polydioxanone, which is an absorbent plate that dissolves in the body over time . The PDO plate is cut to the required length to assist the cartilage and used in combination with autologous cartilage.

Since it is absorbed into the body and melts, it is said that there is a risk that the protrusion of the tip of the nose will decrease and the nose will become lower over time.

A PDS plate remains structurally intact until 10 weeks after implantation and serves as a temporary scaffold. After 25 weeks, the plate is completely degraded without significant effects on the surrounding structures [5,6]. A PDS plate also guides cartilage regeneration, so that New chondrocytes are arranged regularly at the defect area, which prevents cartilage deviation [4]. Using a PDS plate together with cartilage results in increased strength of the cartilage and PDS plate complex. For example, using a 0.15-mm PDS plate with cartilage was found to yield a 3- to 4-fold increase in strength compared to the cartilage alone

References: Feasibility of a polydioxanone plate as an adjuvant material in rhinoplasty in Asians

Advantages and disadvantages of septal extension using meltable thread and nasal septum extension using autologous cartilage

merit Demerit
Septal extension using meltable thread・ Relatively cheap compared to surgically extended nasal septum ・ Short downtime compared to surgically extended nasal septum ・ Short operating time of about 10 to 20 minutes ・ For local anesthesia, intravenous and laughing anesthesia, etc. There is little risk of general anesthesia. ・ It is said that there is almost no need to go to the hospital because there is no need to remove threads.・ The tip of the nose may become too thin and become a pinch nose. ・ The part slightly above the tip of the nose may become a polybeak that swells roundly. ・ The duration is about 1 to 2 years. ・ Injection of local anesthesia.・ You may feel pain due to an allergic reaction to the melting thread, which may cause inflammation. ・ The melting thread may come out from the insertion part.
Septal extension using autologous cartilage・ The effect is semi-permanent because the transplanted cartilage is fixed. ・ Since autologous cartilage is used, there are few allergic reactions and safety is high.・ It takes about a week to fix the cast, and the downtime is longer than the treatment with a meltable thread. ・ Downtime is also required at the cartilage collection site, leaving scars.

Postoperative course and downtime for septal extension using autologous cartilage

Septal extension using meltable thread has a short downtime and does not require going to a medical institution after the procedure, but septal extension using autologous cartilage requires going to a medical institution according to the postoperative course.

3-7 days after surgery

After the operation, fix the nose with a cast for about 3 to 7 days. It may be mixed up, but the thread will be removed after about 7 days. If the cast is removed and the cast is removed on the same day, one visit is required, but if the cast is removed earlier than the cast, two visits are required.
However, some medical institutions require a visit before the thread is removed for follow-up. Please check with your medical institution for the detailed post-treatment visit pace.
You can shower only from the day below the neck, but please do not get the treatment area wet. Also, since there is a risk of infection, please avoid making up the treatment site until the thread is removed.

1 to 2 weeks after surgery

The swelling of the nose is said to subside in a week or two, but it is reddish for several months and the scars are said to fade over time.

1 month to 6 months after surgery

The treatment site may become stiff for 3 to 4 months, but it is said that the hardness gradually improves and the swelling decreases. It takes about 4 to 6 months for the transplanted autologous cartilage to stabilize.
Although it depends on the medical institution, regular medical examinations after thread removal require about 3 visits, 1 month, 3 months, and 6 months.

* There are individual differences in the postoperative course depending on the surgical procedure and constitution.

Precautions for extending the nasal septum

Refrain from smoking before and after surgery

The components of cigarettes have the effect of constricting blood vessels, and it is said that smokers' blood has a low amount of oxygen and a high amount of carbon monoxide. Since blood and oxygen play an important role in healing wounds, smoking makes it difficult to heal wounds, so it is recommended to quit smoking from 2 weeks before surgery to at least 1 month after surgery .

Observe behavioral restrictions for 1 month after surgery

It is said that it takes about 3 weeks to stabilize the nasal tissue . Good blood flow can cause bleeding and prolonged swelling. Please refrain from drinking alcohol, esthetics, strenuous exercise such as gym and yoga, dental treatment and lying down for about a month .

Extension of the nasal septum with a prosthesis

In the case of type I prosthesis, nasal septum extension can be performed even if the prosthesis is already in place, but in the case of type L, it may be removed and replaced with type I.

If you do not want to remove the prosthesis because it depends on the condition of the prosthesis, the surgical procedure, and the policy of the medical institution , please consult with your doctor at the time of examination or counseling .

Design that gives an old impression

Care should be taken when undergoing treatment with the desire to lower the tip of the nose . If you are too concerned about the tip of your nose and want a design that is too low, there is a risk that the entire face will be out of balance because it will become a so-called arrow nose and the nose will look long . The imbalance can give you the impression that you are older than you really are.

At the time of prior examination and counseling, please select a technique that not only conveys your wishes but also considers the doctor's suggestions.

Those who have allergies such as rhinitis and hay fever

If you have allergies such as rhinitis or hay fever, and you have a runny nose or have a strong nasal blow, you need to be careful.

A runny nose contains germs that can cause infections after surgery, and a strong blow of the nose can cause severe inflammation of the surgical site.

Please tell the doctor before the procedure and discuss the appropriate coping method .

Risks and side effects of septal extension

The tip of the nose becomes stiff

Since the septal extension inserts a substance different from the original tissue, the tip of the nose may become stiff after surgery . If the tip of the nose becomes stiff, it may be difficult to move the nose, such as making it difficult to make a pig nose that is pushed up with your fingers.

Postoperative nasal congestion

The incision can cause swelling in the nasal passages, which can lead to difficulty breathing, such as stuffy nose.

It is also related to the size of the original nasal cavity, and if the space in the nasal cavity is narrow or if the septal curvature (the state where the nose is originally bent) becomes inflamed during the procedure, it may cause nasal congestion . .. It is said that when the swelling subsides, it disappears naturally .

If the swelling subsides and symptoms such as nasal congestion do not change, the inserted thread or autologous cartilage may be removed to relieve the symptoms.

Get an infectious disease

Surgery to extend the nasal septum is performed in a sterile condition, but in rare cases, it may become infected with bacteria and the surgical site may become infected . In addition, you may get an infection if you feel a lot of stress after surgery, smoke, or neglect to wet and dry the affected area .

If you have an infection, you may have symptoms such as severe swelling after surgery, difficulty in swelling, and pus from the treatment site. If you suspect that you have an infectious disease, please consult the medical institution that performed the surgery immediately .

It may be necessary to prescribe oral medications such as antibiotics and remove threads and autologous cartilage.

Postoperative relapse and deformation

If the strength of the transplanted cartilage is weak or if the cartilage is unreasonably extended , the nose may bend or the inserted thread may be absorbed and regress slightly after the procedure.

Septal extension is said to be an operation with a high possibility of reoperation even in the formation of the nose, and it is possible to correct it . The period that should be left before re-surgery varies depending on the correction method and how you want to make corrections, so please consult your medical institution if you wish to have re-surgery.

Differences in the effects of septal extension and hyaluronic acid injection on nasal formation

Septal extension is a procedure that can be expected to have an effect on the length and angle of the nose, but hyaluronic acid injection is also expected to have a similar effect. However, it is said that there is a difference in the design and duration that can be performed compared to the extension of the nasal septum that uses meltable thread or autologous cartilage.

Hyaluronic acid is said to have the ability to attract water 200 times its own molecular weight, and is present in the skin, joints, and eyeballs in the body. It is the dermis layer of the skin that has a large amount of hyaluronic acid in the body. In addition to hyaluronic acid, the dermis layer contains proteins such as collagen and elastin, and hyaluronic acid fills the space between collagen and elastin and acts as a cushion.

Originally, hyaluronic acid in the body is viscoelastic but liquid, and liquid hyaluronic acid is not suitable for nose formation. Therefore, when used for the formation of the nose and chin, improvement of the nasolabial fold, etc., hyaluronic acid is bonded to each other and cross-linked to process it into a gel-like structure that is difficult to be absorbed. The hardness and duration of hyaluronic acid vary depending on the method of cross-linking.

Volume can be produced by injecting cross-linked hyaluronic acid into the nose. If you use hyaluronic acid for the same purpose as septal extension, inject hyaluronic acid into the nasal column. It is said that improvement with hyaluronic acid can be expected when the nose hole is widened, and by injecting hyaluronic acid under the skin of the nasal column and extending the nasal column toward the lower part of the nose, from the front. It is said that the hole in the nose becomes difficult to see .

Hyaluronic acid septal extension image

Extension of the nasal septum using meltable thread or autologous cartilage can be expected to be effective in forming the angle of the tip of the nose, but it is said that it is difficult to design the tip of the nose using hyaluronic acid . There are many blood vessels in the tip of the nose, and if you inject hyaluronic acid into the tip of the nose, there is a risk that the blood vessels will become clogged and the skin at the tip of the nose will become necrotic . Therefore, it is difficult to inject hyaluronic acid into the tip of the nose, which makes it difficult to design the tip of the nose.

In addition, hyaluronic acid is gradually absorbed even if it is cross-linked, like the thread that melts, so it is said to have a shorter duration than the extension of the nasal septum that uses autologous cartilage . The duration varies depending on the method of cross-linking hyaluronic acid, but it is said to be about 1 month to 2 years .

Nose plasty other than septal extension

Ryubijutsu

Rhinoplasty is a method of raising the nose as a whole, and surgery is performed using meltable threads and autologous cartilage, similar to the extension of the nasal septum. In addition to meltable threads and autologous cartilage, we may also use medical grade silicone called hyaluronic acid or prosthesis. It is a procedure that can be performed at the same time as surgery to extend the nasal septum .

Nasal tip plasty (Bisenkeiseijutsu)

Nasal tip plasty is a method of narrowing or raising the tip of the nose . It is said that the tip of the nose becomes thinner and higher by suturing the left and right ala cartilage or transplanting autologous cartilage. It can be done at the same time as surgery to extend the nasal septum .

Ala of nose plasty

Ala nose plasty is a procedure to reduce the size of the ala of nose (small nose) . It is said that the ala of nose can be reduced by cutting a small amount of the roots of the nose holes on both sides and suturing them. Ala nose plasty can also be operated on at the same time as the septum is extended .

Price of septal extension

Cost of nasal septum extension using meltable thread

Since the nasal septum extension that does not cut due to the melting thread is not covered by insurance, all treatment costs will be borne by you.

The cost will vary from 120,000 yen to 180,000 yen, depending on the number and type of threads used.

Cost of nasal septum extension using autologous cartilage

Since the extension of the nasal septum using autologous cartilage is a free medical treatment that is not covered by insurance, all expenses will be borne by you.

The cost is JPY 400,000 to JPY 1,100,000 , depending on the type of cartilage to be transplanted and the method of collection.

In addition, anesthesia fee, initial examination fee, and postoperative visit fee may be required separately.

Flow of septal extension treatment

1) Perform medical examination, counseling and design

Tell your doctor what nose design you want for consultation and counseling. At this time, it is important to tell in detail the desired length, shape, position of the tip of the nose, and height of the nose, and to adjust the finish. Failure to match the finished design can lead to treatment failure. However, it is also important to listen to the doctor's opinion as excessive extension of the nasal septum may cause the nose to bend or turn back. Please refrain from performing the procedure until you are satisfied with the examination and counseling.

2) Wash your face

Dirty makeup and skin increases the risk of postoperative infections. Therefore, remove makeup and wash your face to keep it clean.

3) Anesthetize

・ Extension of nasal septum using meltable thread It is said that strong anesthesia is not required for the procedure using meltable thread because it takes less time than the procedure using autologous cartilage and does not make an incision. As a general rule, perform the procedure after giving local anesthesia. Local anesthesia has individual differences in effectiveness, and it is said that in rare cases, pain may be felt. If you feel any pain, tell the doctor immediately.

・ Extension of nasal septum using autologous cartilage As a general rule, treatment using autologous cartilage is performed after general anesthesia or intravenous anesthesia. Whether to use general anesthesia or intravenous anesthesia depends on the surgical procedure, the site of autologous cartilage collection, and the policy of the medical institution, but neither of them feels pain. If you have a desired anesthesia method, please check with your medical institution in advance.

4) Treatment of nasal septum extension

・ Extension of the nasal septum using a melting thread Insert the melting thread from the tip of the nose using a special instrument. It is said that the treatment time is as short as about 15 minutes.

・ Extension of nasal septum using autologous cartilage First, autologous cartilage is collected, and then nasal septum extension is performed. It is said that it takes about 3 to 5 hours throughout, although it depends on the site where autologous cartilage is collected, the surgical procedure, and the medical institution. It is said that there is pain when you wake up from anesthesia, but as a general rule, medical institutions prescribe pain relief.

How to choose a medical institution / doctor to receive a septal extension

Extension of the nasal septum is considered to be one of the most difficult nasal procedures and requires advanced techniques. Therefore, it is necessary to carefully select not only the medical institution that receives the treatment but also the doctor in charge.

First of all, it is important to select a medical institution where the treatment details and fees are clearly presented in advance counseling .

In addition, although anesthesia is used for septal extension, general anesthesia and intravenous anesthesia require the presence of an anesthesiologist. Anesthesiologists include anesthesiologists stipulated by law by the Ministry of Health, Labor and Welfare and certified doctors of the Japanese Society of Anesthesiology. Both are anesthesiologists who are recognized as having sufficient experience and considerable knowledge in performing anesthesia.

If the medical institution that receives the treatment has an anesthesia doctor or a certified doctor of the Japanese Society of Anesthesiology, you can receive the treatment with peace of mind.

The doctor in charge is a doctor who has a qualification in plastic surgery, has abundant experience, likes the case photos taken by the doctor, and has a polite explanation. It is safe to choose.

(Updated January 2021)

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