The Slit Septal Extension Graft: A Technical Modification for Midline Fixation in Structured Rhinoplasty

Abstract Introduction Septal extension grafts (SEG) are widely used to control nasal tip projection and rotation. However, traditional side-to-side fixation may increase graft bulk within the nasal cavity and carries a risk of deviation. The slit extension graft is a modification designed to centralize fixation within the caudal septum while reducing intranasal volume and improving mechanical stability. Objective and Hypothesis To describe the slit extension graft technique and evaluate its structural and angular outcomes in primary rhinoplasty. Study Design A retrospective case series of six patients using the PROCESS guideline. Methods The patients underwent primary rhinoplasty with slit SEG fixation between July 2017 and May 2022. Preoperative and 12-month postoperative nasolabial angles were measured using standardized true lateral photographs aligned to the Frankfort horizontal plane. A paired t -test was used for statistical comparison. Conclusion The slit extension graft provides centralized fixation with measurable angular control and stable outcomes at 1 year. Larger prospective studies are warranted to confirm reproducibility and functional implications.