Septal extension graft is valuable in elongating the nasal length which projects and rotates the tip. It is very effective for improving the nasal tip, therefore, it has widely been applied to correct short noses and drooping tips. In the field of Asian rhinoplasty, many operations are conducted using a septal extension graft, and variable techniques and methods have been introduced by several surgeons. However, there are difficulties in harvesting a sufficient amount of septum from Asian noses, therefore, appropriate designs and definite fixation of a graft are important factors. Furthermore, when applying the harvested septal cartilage to the L-strut, stability depends on the method and the location of the graft fixation. When the graft is unstable due to its pivot motion, the tip will be drooping, deviated and decreased in projection. We herein introduce a pivot locking suture that can firmly stabilize the septal extension graft and explain the factors related with septal stabilization. 
From September 2006 to February 2008, we performed unilateral septal extension graft for aesthetic purposes in 64 patients. After classic compression suture between L-strut and unilateral septal cartilage graft, pivot locking sutures were performed. Pivot locking suture fixed the meeting site of septal extension graft, and cephalic and caudal margin of L-strut using “figure of 8” suture. Then, we confirmed the stability with a vertical stability test and horizontal stability test. 
We could follow up with 20 patients. All patients were satisfied except 2 patients with the tip deviation. Therefore, we believe that pivot locking sutures together with classic compression sutures can overcome limitations of stability inherent with conventional methods, due to unstable septal extension graft cartilage.