The Potential Esthetic Effect of Endonasal Septoplasty on the Cartilaginous Dorsum in Asian Population

Importance: Septoplasty is used to correct nasal obstructions caused by a deviated septum. In some patients, septal deviation is also associated with external nasal deformity, which suggests that proper septoplasty can improve external deformities as well. However, objective studies of the esthetic outcome of septoplasty are limited. Objective: To investigate the potential esthetic outcome of correction of septal in addition to its functional purpose of treating nasal obstructions. Design, Setting, and Participants: Retrospective chart analysis of prospectively collected data was conducted for patients who underwent septoplasty performed by a single surgeon at our clinic. Ninety-five patients who had preoperative and postoperative medical photographs were enrolled. Main Outcomes and Measures: We measured the mid-vault dorsum angle (MDA) from a bird's eye view to evaluate the objective esthetic outcome. The nasofrontal angle and the nasolabial angle were also included in our analysis. Differences in preoperative anthropometric measurements and application of specific surgical techniques were additionally analyzed. Results: The mean age of the participants was 39.1 years (male: 85.2%, female: 14.8%). The average preoperative MDA was 3.41° ± 3.05°, and the postoperative MDA was 1.88° ± 1.09° (p < 0.001). In the severe dorsum deviation group (MDA >4°, N = 31), angle measure improvement was prominent (3.82° ± 2.97°, p < 0.001). The correlation analysis revealed that a higher preoperative MDA had a significant correlation with a higher angle improvement postoperatively (r = 0.7, p < 0.001); this outcome was also observed in the severe dorsal deviation group (r = 0.6, p = 0.003). In addition, we found a positive correlation between the bony septal deviation angle on computed tomography and preoperative MDA (r = 0.51, p = 0.003). Conclusions and Relevance: In some cases with significant external dorsum deviation, septoplasty via an endonasal approach can yield positive esthetic outcomes in addition to functional improvements. This finding will benefit patient counseling and also provide important surgical concepts in rhinoplasty with an emphasis on a gradual surgical approach to correcting external nasal deformity.