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Dr. Barry Eppley

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The Anterior Septal Angle in Rhinoplasty


The open approach is the most commonly used technique in contemporary rhinoplasty. Whether it is a primary nose or a secondary revision, the open approach provides wide access and visualization of all nasal structures. But once inside how does the plastic surgeon decide to proceed?.

In the March 2017 issue of the journal Plastic and Reconstructive Surgery, an article was published entitled ‘The Importance of the Anterior Septal Angle in the Open Dorsal Approach in Rhinoplasty’. In this review paper the authors discuss the importance of the anterior septal angle as it contributes to nasal tip support and length as well as internal nasal valve anatomy and airway function. There are many important nasal maneuvers that can be from the anterior septal angle from spreader grafts, septal angle reduction, septoplasty and cartilage harvest to caudal septal resection and the placement of columellar strut grafts.

The importance of the anterior septal angle is described using the four gateways. The dorsal gateway allows for dorsal aesthetic line creation/restoration, septal reduction and spreader grafts and correction of the deviated noise with spreader grafts. The posterior gateway allows for airway obstruction improvement by septal correction back to the vomer as well as cartilage harvest with emphasis on maintaining 10 to 15mms of L-shaped septal construct. The nasal tip gateway looks at the role that the anterior septal angle plays in tip support, specifically the use of septal extension grafts to control tip projection and shape. Anterior septal angle reduction can also be done in the tension nose to help widen the external and internal valves. The caudal gateway allows for the placement of columellar strut grafts and depressor septa muscle transection.

What has become apparent after decades of performing open rhinoplasty surgery is that the identification of the anterior septal angle is the first step after exposure or degloving of the nose is done. From this anatomic point all structural changes can be initiated.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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