Among several techniques to maintain the lengthened cartilagenous tip structure, septal extension
graft with septal cartilage or rib cartilage is most widely used. But in many cases, nasal tip rigidity with
unnatural appearance on smiling is one of the major drawbacks of septal extension graft. The authors
used a piece of elastic cartilage graft harvested form ear that can act as a cushion buffer between alar
cartilage and septum instead of directly fixing the alar cartilage to extended septum for obtaining a
less stiff nasal tip with sufficient nasal tip elongation. We called this graft "derotation graft". Derotation
graft was performed in 1197 patients via the open nasal approach. Among them, 432 (36%) patients
had preoperative short nose deformity and 765 (64%) patients developed intraoperative cephalic
rotation of the tip resulting from procedures for tip projection such as columellar strut. Excellent
results were achieved in 1110 (93%) patients. 87 (7%) patients had unsatisfactory results requiring
a revision surgery because of overcorrection or undercorrection of tip rotation, poor tip projection and
visible graft on supratip. Derotation graft is a simple, and effective procedure for short nose correction
preventing with less post-operative nasal tip rigidity.