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2025.12.14
What is Nasal Septum Extension Surgery?｜A procedure that reconstructs the "foundation" rather than the "shape" of the nasal tip
As a board-certified plastic surgeon, I have handled numerous cases involving trauma, reconstruction, and congenital conditions, cultivating precise techniques and deep anatomical understanding. Driven by the desire to deliver the transformative power of beauty—where visible change uplifts the spirit—I pursued a career in cosmetic surgery. My areas of expertise include comprehensive eye treatments, injectable therapies, and anti-sagging procedures. Guided by a commitment to sincerely address each patient's aspirations, I provide meticulously crafted treatments focused on achieving beauty.
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Designing natural beauty with trust.
I am Masataka Fujihashi, a board-certified plastic surgeon.
When considering rhinoplasty, you may come across the term "nasal septum extension," but many people find it difficult to understand exactly what kind of surgery it entails.
Septoplasty is not a procedure that directly shapes the tip of the nose,Surgery to reconstruct the nasal support structure = foundationis.
The tip of the nose is not solely supported by skin and soft tissue.
Inside the nose, skeletal structures such as the alar cartilage and nasal septum cartilage provide support. If only the external shape is adjusted without strengthening this underlying framework, deformation and instability are likely to occur over time.
Septum extension surgery is a procedure that directly addresses this "foundation itself."
Source: 'Rhinoplasty, First Edition' (Sankei Publishing Co., Ltd., 2017), p.246, Figure 11-37, partially modified and reproduced.
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■ The Basic Concept of Nasal Septum Extension Surgery
Septoplasty is, in English,Septal Extension Graft(SEG) is called.
Cartilage is transplanted to the tip or lateral side of the nasal septal cartilage (the cartilage dividing the left and right sides of the nose),A foundation that enables three-dimensional control of the tip's position, orientation, and supportI will make。
The key point is that it allows for structural design that determines "in which direction," "at what position," and "to what degree of stability" is desired.
The design of the nose tip is not determined simply by increasing its height or making it thinner.
What's important is,In which direction and by how much the nose tip is extended, and whether the supporting structure provides sufficient support and stabilityis.
If the extension is excessive or the supporting structure is weak, raising the nose too high can cause the tip to tilt or become unstable.
Therefore, it is essential to design with consideration not only for the cartilage structure but also for its balance with the envelope (skin and soft tissue).
Source: 'Rhinoplasty, First Edition' (Sankei Publishing Co., Ltd., 2017), p.248, Figure 11-39, reproduced with modifications.
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■ Primary Indications for Nasal Septum Extension Surgery
Septoplasty is considered in the following cases:
・I want to precisely control the position and orientation of the nose tip.
・Structural stability is deemed insufficient with nasal tip reshaping alone.
・The alar cartilage has been damaged due to a previous surgery.
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■ This is ideal for people like this.
・For those who want to build solid height and don't want to backtrack
・Individuals with a small nasal septal cartilage and alar cartilages that flare outward on both sides
・Those with inverted triangular nostrils and a flat upper edge of the nostrils
・Individuals whose nasal tip has become deformed due to prolonged use of L-shaped prostheses
・Individuals whose alar cartilage has been deformed due to multiple nose surgeries
・For those who prioritize stability in the position and angle of the nose tip
・Individuals with limited skin and soft tissue envelope
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■ Cases where septal extension surgery is not suitable
On the other hand, not everyone is a suitable candidate for nasal septum extension.
In cases of severe nasal septal deviation or a history of septoplasty or nasal extension surgery, careful consideration is required to determine whether further extension is feasible.
Thorough preoperative examination and structural evaluation are essential.
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■ The Importance of Confirming Structure via CT
In nasal septum extension, it is extremely important that the nasal septum, which serves as the fulcrum, is straight.
If extended while bent, the pivot point may become fixed at an angle, potentially leading to a crooked nose tip.
Therefore, we use CT scans before surgery to assess the condition of the bone and cartilage and determine whether there are any structural issues.
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■ Summary
Nasal septum extension is not a procedure to reshape the tip of the nose.
Surgery to reconstruct the structure supporting the position, orientation, and stability of the nasal tipis.
This is a crucial choice for achieving a nose that remains stable over time and looks natural in facial expressions.
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【Profile】
Masataka Fujihashi, MD, Plastic Surgeon
Leveraging expertise as a board-certified plastic surgeon, I offer comprehensive facial cosmetic procedures including eyelid and nose surgery, facial liposuction, thread lifts, and hyaluronic acid injections. From incisional surgeries and revision procedures requiring delicate design to minimally invasive injections and lifts with minimal downtime, I strive to provide treatments tailored to each patient's ideal outcome.
We are dedicated to achieving natural results and minimizing downtime, pursuing medical care that leaves you feeling confident in your choice through sincere consultations.
Designing natural beauty with trust.
We cherish that sentiment and apply it to our daily practice.
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【Career】
March 2015: Graduated from the School of Medicine, Showa University
April 2015 Showa University Yokohama Northern Hospital Initial Clinical Training
April 2017 Showa University Hospital Department of Plastic Surgery
October 2017 Maebashi Red Cross Hospital Plastic Surgery / Cosmetic Surgery
April 2019 Nishio Municipal Hospital Plastic Surgery Department
April 2020 Showa University Fujigaoka Hospital Plastic Surgery Department
November 2020 Ota Nishinouchi Hospital Plastic Surgery / Cosmetic Surgery
July 2022 Tokyo Rosai Hospital Plastic Surgery / Cosmetic Surgery Department Head
July 2022: R.O.clinic (Part-time), Kusano Taro Clinic (Part-time)
April 2024 Deputy Director, Ginza TA Clinic
November 2025 BIANCA CLINIC
【Professional Affiliations and Qualifications】
Japanese Society of Plastic and Reconstructive Surgery Board-Certified Plastic Surgeon
Member of the Japanese Society of Aesthetic Plastic Surgery (JSAPS)
Member of the Japanese Society of Aesthetic Surgery (JSAS)
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