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Figure 1. (A) A traditional spreader graft spanning the length of the upper lateral cartilages. (B) Axial view of spreader graft placement
functioning to open the internal nasal valve. Image courtesy: Porter et al. [18] .
Figure 2. Intraoperative image of bilateral extended spreader grafts. A caudal septal extension graft is shown by the black arrow. Image
courtesy: Porter et al. [18] .
Correction of lower third
Persistent deviation of the lower third or nasal tip following adequate correction of the middle third and
bony vault is secondary to either persistent caudal septal deviation or lower lateral cartilage asymmetry.
Correcting a deviated caudal septum
A persistently deviated septum is a common source of failure following prior surgery to straighten the nose.
More conservative, less invasive traditional septoplasty techniques are sometimes insufficient to correct a
complex caudal septal deviation. Correcting a caudal septal deviation depends on the area of displacement
