Septorhinoplasty in Asians is very challenging in terms of shortage of septal cartilage. Many cases in
correction of dorsal and caudal septal deformities requires septal surgery including cartilaginous graft.
Septoplasty is a well-known procedure which preserves majority of quadrangular cartilage, however, it
is hardly adopted in Asians. The preoperative evaluation is accomplished using nasal endoscopy. The
posterior and inferior chondrotomy for septal swinging-door procedure can be performed under
endoscopic view. Also, the precise amount of bony spur and excessive cartilage can be excised.
Endoscopy is also indispensable to precise hemostasis and turbinoplasty. Asian septoplasty is usually
performed with maximal central submucous resection leaving critical L-strut, because surgeons need as
much cartilages as possible for proper graft. In caudal septum, posterior septal angle loses its integrity
after swinging-door procedure, and also loses the tip projection. This should be reinforced. Furthermore,
in patients who have weak septal cartilage, key stone area needs to be reinforced by unilateral or bilateral
spreader graft at the same time. Proper bilateral strut at the posterior septal angle continuous with
spreader graft at rhinion may confirm the newly made solid L-strut. This solid caudal septum will be the
new nasal base for the next tip plasty. (J Korean Soc Aesthetic Plast Surg 16: 111, 2010)