“My Nose Is Stiff and Crooked”: Septal Extension and Cartilage Grafts in Rhinoplasty
Summary
Many modern rhinoplasties use cartilage grafts, often a septal extension graft, to shape and support the nasal tip. When planned and placed well, grafts give strong, lasting results. When they aren’t, people can be left with a stiff or crooked tip, breathing problems, or the need for revision surgery. This guide explains what these grafts are, with a diagram, the risks, the rules for cosmetic surgery in Australia, and when a poor result might point to care that fell short.
Quick answer · updated November 2026
A septal extension graft is a piece of cartilage fixed to the septum to control the length, projection and rotation of the nasal tip. It can make the tip stiffer, and poor placement can cause deviation or breathing problems. Since July 2023, cosmetic surgery in Australia has required two consultations, a seven-day cooling-off period and the surgeon personally obtaining consent. If you weren’t told about graft risks, or your result is poor, you can ask for your records.
Rhinoplasty with grafts at a glance
- 1ConsultationsTwo, at least one in person with the surgeon.
- 2The planWhich grafts, from where, and why.
- 3Cooling offAt least seven days before booking or paying a deposit.
- 4RecoverySwelling can take months; results up to 12 months.
- 5If it’s not rightGet your records and an independent opinion.
At any stage: fever, heavy nosebleeding, worsening pain or spreading redness after surgery needs urgent review.
I’d hated the droop of my nose since I was a teenager. At thirty, after years of saving, I booked a consultation with a surgeon whose Instagram was full of beautiful before-and-afters.
He said I needed a “septal extension” to lift and strengthen the tip. He drew it on a tablet in about thirty seconds. I didn’t really understand, but it sounded advanced.
A year later, the swelling was long gone. The tip of my nose felt hard as a knuckle and pointed slightly to the left. I couldn’t breathe through my right side.
When I smiled, my upper lip pulled tight under my nose in a way it never had before.
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
If your rhinoplasty left you with a stiff, crooked or blocked nose, I want you to know that your concerns are valid. Cosmetic surgery is still surgery, and you were entitled to proper information and care.
This guide covers what septal extension and other cartilage grafts do, their risks, the rules for cosmetic surgery in Australia, what your records should show, and how the law looks at a poor result.
Why I can write this
I have been a medical negligence lawyer since 2014 and have worked on many hundreds of claims, including many involving cosmetic surgery. My doctorate looked at patterns of failure in medical negligence. I am not medically qualified. The clinical facts in this article are checked against named sources, listed in the references, and I explain how I work in our editorial standards.
Start with your question
- What is a septal extension graft?
- Where does graft cartilage come from?
- What are the risks of a septal extension graft?
- How long does rhinoplasty swelling last?
- What are the rules for cosmetic surgery in Australia?
- Can a septal extension graft be revised?
- Could a poor rhinoplasty result be negligence?
What a septal extension graft does
A septal extension graft is a piece of cartilage fixed to the septum, the wall dividing the two sides of the nose, extending it towards the tip. A 2023 review describes it as letting the surgeon control tip projection, rotation, length and shape.1
A septal extension graft
The nose from the side
The septum is the cartilage wall inside the nose. The pink piece is the graft.
- The graft. Fixed to the septum, it supports and positions the tip.
- The septum. The graft is anchored here. If it overlaps unevenly, the tip can turn to one side.
- The tip and nostrils. A strong graft can make the tip firmer and less flexible, and too much can narrow the airway.
A simplified drawing, not to scale.
Where the cartilage comes from
Cartilage for grafts can be taken from inside the nose, the ear or other parts of the body.2 Rib cartilage is used when more is needed, and the review notes it carries a risk of warping and of problems at the donor site, while ear cartilage can be less stable.1 You should be told where your cartilage will come from, and the extra risks of each source.
Definition
Warping means a cartilage graft bending or changing shape after surgery.
In plain terms: the graft can slowly curve, pulling the nose crooked.
The risks
The review reports that septal extension grafts can make the tip rigid, that a graft overlapping the septum can cause the tip or columella to deviate, that too large a graft can collapse the internal nasal valve and affect breathing, and that the technique has a learning curve.1 healthdirect lists general rhinoplasty risks including infection, ongoing pain, numbness, reduced sense of smell, thick scarring and difficulty breathing from narrowed airways, and notes that further surgery may be needed.2
Questions to ask before surgery
- Which grafts do you plan to use, and why do I need them?
- Where will the cartilage come from?
- Will my tip feel stiffer afterwards?
- How will you protect my breathing?
- How many of these do you do, and what is your revision rate?
- What will revision cost if it’s needed?
The rules for cosmetic surgery
Since 1 July 2023, Medical Board of Australia guidelines require patients to be referred, preferably by their usual GP; at least two consultations before surgery, at least one in person with the surgeon; and a cooling-off period of at least seven days after consent before surgery is booked or a deposit paid. The surgeon must personally obtain consent, give written information about risks and realistic outcomes, screen for body dysmorphic disorder, and give full cost information including possible revision costs.3
Recovery
healthdirect says swelling may take several weeks or even months to go down, and results may take up to 12 months to appear.2 Early judgment can be misleading, but stiffness, deviation and breathing problems that persist after this time are worth assessing.
Expected, worth a review, or urgent
Usually expected
- Swelling for weeks to months
- A firm tip early on
- Some numbness
In plain terms: give it time, and keep your follow-ups.
Raise at review
- The tip turning to one side
- Blocked breathing on one side
- Tightness of the upper lip
- Pain at a rib or ear donor site
In plain terms: ask for these to be documented.
Urgent
- Fever
- Heavy nosebleeding
- Pain getting worse
- Increasing redness
In plain terms: contact your surgeon or go to emergency.
Revision
Revision after a septal extension graft can be complex, because the graft may need to be removed, reshaped or replaced, sometimes with rib cartilage. Get your operation report before seeing another surgeon, so they know exactly what was used.
The second surgeon I saw read my operation note and said the graft had been fixed overlapping my septum on one side, and was too long. It was pushing my tip over and blocking my airway.
When I looked back at my paperwork, the consent form said “rhinoplasty +/- grafts”. Nothing about stiffness, deviation or breathing. I’d signed it at my first and only consultation, and paid my deposit the same day. That was in 2024, after the new rules came in.
The revision took rib cartilage. I have a scar on my chest now, too.
My best friend came with me to the revision consult and held my hand while he showed me the scan. “You didn’t do anything wrong,” she said. “You asked a surgeon you trusted.”
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
What to look for in the records
Your records are often where the story becomes clear. You have a right to access your own health information. In NSW the Health Records and Information Privacy Act 2002 covers both public and private providers, and the Information and Privacy Commission explains how to ask.4 Our step-by-step guide to getting your medical records in Australia walks you through it.
| Record | Why it matters |
|---|---|
| Referral and consultation notes | Show whether there was a referral and two consultations. |
| Consent form and information sheets | Show which risks were explained, and when you signed. |
| Financial consent and receipts | Show when you paid, and whether cooling off was respected. |
| Operation report | Records which grafts were used, their source, and how they were fixed. |
| Photos | Before, and at intervals afterwards. |
| Follow-up notes | Show the concerns you raised and the response. |
| Your own diary, photos and messages | Notes made at the time are evidence too. Keep them. |
How the law looks at it
A disappointing rhinoplasty result is not automatically negligence. Noses heal unpredictably, and revision is a recognised possibility. The legal questions are whether the surgery and the consent process met the standard expected, and whether any shortfall caused harm.
A claim usually turns on three questions: whether the care fell below what peers would widely accept as competent practice (section 5O of the Civil Liability Act 2002 (NSW))5, whether that shortfall probably caused harm you wouldn't otherwise have had (Tabet v Gett)6, and, where it matters, whether you were told the material risks first (Rogers v Whitaker)78. Our guide to how a medical negligence claim works explains each one in plain terms.
In a septal graft case, the questions might be: was the graft appropriate for your nose? Was it placed and fixed properly? Were risks like stiffness, deviation and breathing problems explained? Were the 2023 cosmetic surgery guidelines followed, including two consultations and cooling off? Were concerns after surgery taken seriously?
In plain terms, the question is whether better surgery or better information would probably have avoided the deviation, breathing problem or revision.
For rhinoplasty with grafts, that would usually include stiffness, deviation, breathing problems, donor-site problems and the chance of revision.
Who can claim, and when
The person who had the surgery can claim. In NSW, time usually runs from when you knew, or ought to have known, enough to claim, not from the treatment itself, and courts can sometimes extend it, so an old injury may still count. See time limits in NSW or other states, and ask early.
More: complaint or claim? · how a claim is paid for · what a claim can cover
In my practice
In rhinoplasty files, I often see consent forms with “+/- grafts” and nothing more, and consultation notes that are a few lines long. Since July 2023, the rules have been clear, and checking them against the paperwork is often revealing. The operation report usually tells a second surgeon exactly what went wrong.
Both things can be true
Cosmetic surgery is a choice, and you may still have been owed better information and care. Wanting a nose you liked is not a reason to accept a nose you can’t breathe through.
The bigger picture
Cosmetic surgery in Australia has been the subject of major reform, including the 2023 guidelines.3 Concerns can be raised with the Ahpra cosmetic surgery hotline on 1300 361 041,9 and you can check a practitioner’s registration on the Ahpra public register.10 Complaints in NSW can also go to the Health Care Complaints Commission.11
Our cosmetic and breast surgery page brings together related guides.
Support
You don't have to work through this alone. These services can help:
- Lifeline, 24-hour crisis support: 13 11 14 (listed on healthdirect's helplines page)12
- Beyond Blue, anxiety and depression support: 1300 22 4636
- Medicare Mental Health, help finding mental health support: 1800 595 212
- healthdirect, 24-hour nurse advice: 1800 022 222
- Health Care Complaints Commission (NSW): 1800 043 159
A woman who couldn’t breathe through one side of her nose now knows exactly why. You deserve that understanding too.
With care,
Rosemary
Frequently asked questions
What is a septal extension graft?
Cartilage fixed to the septum to control the length, projection and rotation of the nasal tip.
Will a septal extension graft make my nose stiff?
It can make the tip firmer and less flexible. Ask about this before surgery.
Where does graft cartilage come from?
From inside the nose, the ear, or sometimes the rib.
How long does rhinoplasty swelling last?
Weeks to months; final results can take up to 12 months.
What are the rules for cosmetic surgery in Australia?
Since July 2023: a referral, two consultations, seven days’ cooling off, and consent from the surgeon personally.
Can I claim for a bad rhinoplasty?
You may well have a claim if surgery or consent fell below the accepted standard and that caused harm.
Questions about your rhinoplasty?
When you're ready, and not before, I can look at what happened and help you understand your options.
Cosmetic and breast surgery guides
- “My nose is stiff and crooked”: Septal extension and cartilage grafts in rhinoplasty (you are here)
- Breast implant rupture and leakage
- Infection after breast implant surgery
Part of our guide to cosmetic and breast surgery. Not sure where you stand? Try the free claim checker.
References
- Kurt Y, Oğuz O, Bayar Muluk N, Cingi C. Caudal septal extension grafts: conchal cartilage or PDS foil-empowered nasal cartilage. European Review for Medical and Pharmacological Sciences. 2023;27(5 Suppl):95–100.
- healthdirect. Rhinoplasty (nose surgery).
- Medical Board of Australia. Guidelines for registered medical practitioners who perform cosmetic surgery and procedures. 1 July 2023.
- Information and Privacy Commission NSW. Fact sheet: Accessing your health information in NSW.
- Civil Liability Act 2002 (NSW) s 5O, Standard of care for professionals.
- Tabet v Gett [2010] HCA 12.
- Rogers v Whitaker [1992] HCA 58; (1992) 175 CLR 479.
- Australian Commission on Safety and Quality in Health Care. Informed consent.
- Australian Government Department of Health. What you need to know before deciding on cosmetic surgery.
- Australian Health Practitioner Regulation Agency. Register of practitioners.
- Health Care Complaints Commission NSW. Home page.
- healthdirect Australia. Mental health helplines.
Stories in this article are composites, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. They do not describe any individual client.
Dr Rosemary Listing, PhD (Law), Medical negligence lawyer since 2014 · Of Counsel, Peter Evans & Associates. Rosemary's doctorate examined patterns of failure in medical negligence, and she teaches health law at the University of Newcastle. She is not medically qualified. About Rosemary.
Last updated: 10 November 2026 · First published: 10 November 2026 · Next review: May 2027
Cite this article: Listing R. “My nose is stiff and crooked”: Septal extension and cartilage grafts in rhinoplasty. Reframe Legal. Published 10 November 2026. https://reframelegal.com/septal-extension-graft-rhinoplasty/
This article is general information, not legal or medical advice. It does not create a lawyer–client relationship. Speak to your treating clinicians about your health, and get legal advice about your own situation.
If you are in danger or need urgent medical help, call 000. For crisis support, call Lifeline on 13 11 14.
Legal services are provided by Peter Evans & Associates.
