"If you have nose surgery during growth phases, facial development stops"—half a century ago, a California research laboratory provided one answer to this concern[1]. To state the conclusion upfront: if you choose the right surgical technique, any difference in facial development is imperceptible to the naked eye. However, there are conditions.
The most common question in consultations is this:
"If I have surgery on my nasal septum (the partition inside the nose) during my growth phase, could my face become asymmetrical in the future?"
For middle & high school students considering septum extension surgery, what they're really concerned about ultimately boils down to this one point. A 1973 puppy experiment provided some framework for answering this question.
What people who search for "middle & high school septum extension surgery" are really anxious about
Conclusion: Even though the search terms differ, the underlying worry is"Is it okay to surgically intervene in a nose that hasn't finished growing?"—just this one point.
The search term "middle & high school septum extension surgery" tends to take on a life of its own online. In our consultation practice, 80% of patients expressing the same anxiety are actually struggling with one of the following:
- Whether it's okay to surgically treat a child's nasal obstruction
- Whether having rhinoplasty in the late teens will collapse facial contours
- Whether surgical scars will remain raised or hypertrophic
- Whether addressing volume deficiency around the nose will interfere with growth
This column is built around a pilot study of canine pups published by Bernstein in 1973[1]. An experiment in which nasal septal cartilage was excised from puppies aged 4–6 weeks and followed for over 10 months. While the work is dated, research directly addressing nose surgery during growth phases and facial development remains scarce today.
Additionally, for those concerned about scarring, surgical treatment of keloids[3]、Fat transplantation, which has become a hot topic for volume adjustment around the nose[2]also touches on related areas.
"Middle and high school students wanting nasal septal extension" — what you'll understand in the next 5 minutes is thesafe zone for nasal surgery during growth periodsshown by puppy data from half a century ago. The following section traces that experimental design.
Experimental stage: A mixed-breed puppy weighing 2.5 kg, a microscope, and quadrangular cartilage
Conclusion: To simulate surgery on human children,Puppies aged 4–6 weeks and weighing 2.0–2.5 kgwere used in the experiment[1].
Bernstein sought to carefully replicate in an animal model what would happen if children underwent an orderly submucous resection of the nasal septum (a surgical technique that removes only the cartilage while preserving the mucosa)[1]Why puppies? Because their body size, growth rate, and cartilage dimensions are easy to match with the conditions for rhinoplasty in human children.
The surgical technique is "performed with minimal necessity."
The procedure was straightforward.
- Dorsal midline incision (cutting vertically down the center of the nose)[1]
- Hemostasis of the subcutaneous layer using electrocautery[1]
- Exposure of the upper lateral cartilage (corresponding to human lateral nasal cartilage) and manipulation under a surgical microscope[1]
- Partial excision targeting only the quadrilateral cartilage (the cartilage forming the center of the nasal septum)[1]
As a meticulous point,The mucoperichondrium (thin membrane enveloping the cartilage) on the opposite side is left almost entirely intactThis practice is strictly maintained.[1]Only the necessary portion is separated, and only the targeted cartilage is removed. This meticulousness influenced the subsequent findings.
The excised location was recorded "divided into four sections"
The nasal septum is divided into four quadrants—dorsal, ventral, anterior, and posterior—and the location and amount of tissue removed is recorded on the puppy's cartilage outline[1].
In the first group, since no observable changes in appearance were seen even after 10 months, Bernstein tightened the conditions. In the next 6 dogs,he nearly completely removed the quadrangular cartilage,switching to a more aggressive experiment,[1].
The placement of controls is subtly important. By even preparing for "non-surgical procedures,"whether the face becomes distorted because cartilage was removed, or becomes distorted simply by peeling back the mucosa,we are working to distinguish between these factors.[1].
What is important to understand is one point — when considering nasal septal extension in middle and high school students, half a century ago, the researcheraligned controls at different stages of intervention,and tracked the changes.
After 10 months, the puppy's face had grown,
Conclusion: Between the puppies that underwent surgery and the control group,no discernible difference appeared in the nasal dorsum and the central third of the face,[1].
"If you remove the cartilage, the nose should cave in." Bernstein's observation quietly contradicted that intuition.
Timeline tracking shows the following:
Since the puppy's nasal interior was unexaminable in the awake state,we had no choice but to work backward from external appearance and final histological findingsthere was this constraint:[1]. Despite this, Bernstein matter-of-factly records that "no signs suggesting postoperative complications appeared in the puppies"[1].
External findings
- No findings indicating developmental delay in the nasal bridge or central third of the face[1]
- No irregularities in teeth occlusion (occlusion)[1]
- Between surgery and euthanasia, the nasal septal cartilageApproximately doubled in all 3 directions (vertical, horizontal, and depth)grew to[1]
Furthermore, even when the extracted nasal septum was illuminated with intense transmitted light,it was extremely difficult to identify the surgical siteas noted[1]and there were zero cases of perforation (holes) in the nasal septum[1].
findings observed under the microscope
Thin sections were observed with hematoxylin-eosin staining (standard tissue staining), and in some cases Koneff staining (triple staining with methyl green, aniline blue, and hematoxylin, which is said to indicate newly formed cartilage)[1]This staining result provided confirmation of the gross findings.
- New cartilage growth was confirmed in all subjects that underwent surgery[1]
- In some cases, absorption of the original cartilage (a phenomenon where tissue dissolves and disappears) also occurred concurrently[1]
- There were examples where the two cut ends healed cartilage-to-cartilage without fibrous tissue interposing[1]
"The cut site becomes difficult to locate 10 months later"——the strength of this clinical implication is the core of this study. This is not insignificant data when considering the concerns of middle and high school students about nasal septal extension.
The next chapter addresses what happens if wereturn the cartilage that was cut and removed——we enter a branching experimental study of autografting.
Returning excised cartilage——the quiet conclusion of autograft transplantation
Conclusion: When excised cartilage is simply returned to its original position,the graft remains viable and grows at approximately the same pace as the surrounding tissue[1].
Bernstein separately set up an experiment in 6 subjects in which the central portion of the septal cartilage was once harvested and returned to its original position without fixation[1]The mucoperichondrium was simply replaced in its original position without suturing the graft[1].
- The transplanted cartilage became incorporated, and remained alive and intact on gross examination[1]
- Although there was some early or concurrent absorption,growth continued at approximately the same rate as the nasal septum as a whole[1]
The clinical implication drawn from this is straightforward: when handling cartilage in nasal surgery during the growth period,a design that "returns or reconstructs" rather than "removes and discards" can minimize the impact on developmentThe option of autografting has held validity in this context for half a century.
If we reconsider the concerns about nasal septal extension in middle and high school students from another angle, what matters isnot whether the cartilage was cut, but how it is handled afterward——this perspective is gained.
Nevertheless, the story doesn't end there. The "unexpected resorption" that occurred in the control group became another lesson in surgical design.
The upset on the "non-incision side"——the lesson from the control group
Conclusion: In control puppies where the mucoperiosteum was elevated on only one side,the quadrangular cartilage and lateral cartilage were almost completely resorbedIn contrast, in the bilateral-elevation controls, the cartilage remained[1].
a result contrary to intuition. Without touching the cartilage with a scalpel at all,on one side onlyin 4 puppies where the mucoperiosteum was widely elevated, the quadrangular cartilage and dorsal lateral cartilages were almost entirely resorbed[1]. Yetno facial deformity visible from the outside appeared[1].
whereasin both sidesin 2 puppies where the mucoperiosteum was elevated bilaterally, cartilage resorption did not occur, and they were indistinguishable in appearance from the other controls[1].
why resorption occurred on only one side
Bernstein avoided making a definitive claim, butthe possibility of subclinical infection (mild infection without obvious symptoms) in the hematoma beneath the mucoperiosteumis raised[1]. All 4 puppies were littermates from the same litter, and the postoperative course visible from the outside was entirely uneventful.
Applying this to the context of septal extension in adolescents, the lesson from this reversal phenomenon is one.rather than whether to cut the cartilage or not, the blood supply around it, infection control, and the handling of the perichondriumare what determine the outcome[1].
Cartilage is delicate, but the face's appearance is tougher than imagined——this asymmetry also applies to modern nasal reshaping design.
Answering adolescent septal extension concerns with 1973 data——but with 3 caveats
Conclusion: The puppy experiment offered hope, but to extrapolate it directly to human growth periods requires3 reservations.
By this point in the reading, you should already see that growth period = do not touch is far too simplistic a formula.Most of the concerns lurking behind the search term 'nasal septum extension in middle/high school students' can be avoided by choosing the right surgical technique——that was the implication of the 1973 data. However, keep the following in the back of your mind.
1. First of all, this is a story about 'puppies'
Bernstein himself noted at the end of the paper,'The study should be replicated in more homogeneous animal populations, preferably primates'.[1]There is no guarantee that differences unseen in mixed-breed puppies will not appear in humans. Before concluding that pediatric nasal surgery is 'safe' by the same logic, individual suitability assessment is essential.
2. The premise is 'careful submucosal dissection'
What this experiment envisioned was a simulation of'orderly submucosal dissection'in children, not rough cartilage destruction.[1]When other researchers performed near-total resections in rabbits or different puppies,'nasal dorsum and midface growth was clearly suppressed'—contrasting reports exist.[1].
3. Post-operative 'scarring' is a separate issue
For those with a tendency toward raised scars around the nose (keloids or hypertrophic scars), different preparation is needed. Even in Pollack and Goslen's review of keloid surgical treatment,'combination with post-operative adjuvant therapy'is the standard premise.[3]The 'nasal scarring' issue that appears alongside searches for 'nasal septum extension in middle/high school students' is best judged separately from effects on growth.
In cases where fat injection is considered for volume correction around the nose, as Coleman outlined,'donor site selection, pre-operative marking in standing position, and aseptic technique'are fundamental principles that influence results.[2]These are items that need to be considered alongside growth.
If you understand the caveats and plan accordingly, pediatric nasal surgery remains a viable option——that is the summary up to this point.
Q&A: 5 Frequently Asked Questions
Conclusion: Most of your concerns can be resolved outside the false binary of 'cutting or not cutting'.
Q1. If my child undergoes nasal septum correction surgery, will their face become asymmetrical in the future?
In Bernstein's puppy experiments,no gross developmental impairment was observed with careful submucosal resection[1]. Final judgment in humans depends on the combination of age, skeletal maturity, and specific surgical technique. We are at a stage where further primate studies are needed[1].
Q2. If we remove a lot of cartilage, won't the nose become lower?
Other animal studies showedgrowth suppression with extensive resection—the opposite result[1]. The resection volume and surgical design determine the outcome.
Q3. Is 'non-cutting' surgery safe?
In Bernstein's control group,cartilage resorption occurred in cases where only the perichondrium was elevated without incision.[1]'Non-cutting' = safe is scientifically oversimplified.
Q4. I'm afraid of keloid scarring after surgery
For patients with keloid-prone skin, the literature outlines strategies combiningintralesional steroid injection, pressure therapy, and skin grafting.[3]This is an area where we evaluate constitutional risk in advance and design accordingly.
Q5. Can fat transfer be used for volume correction around the nose?
There are fundamental principles: donor site selection, marking in the standing position, sterile technique, and others[2]. Application in growing humans is a matter of individual counseling judgment.
If you have remaining questions, please move on to the next chapter.
If you're wondering, 'What about my case?'
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Summary — having read this far, you are now beyond "vague anxiety"
Conclusion: The anxiety tied to the search term "nasal septal extension in middle and high school students" can be broken down into3 specific decision pointsif you raise the resolution with correct information.
To recap, it goes like this.
- In puppy experiments,careful submucosal resection showed no visible difference in facial development[1]
- The harvested cartilageautografted back to its original positiontook and continued to grow[1]
- The handling of mucoperichondrium, blood supply, and infection control determined the fate of the cartilage[1]
- reaching final conclusions in humans requires further verification including primates[1]
- Scar and volume correction are separate areas of treatment[2,3]
It all comes down to whether your case fits these criteria. Your age, skeletal maturity, whether your nasal concerns are functional (breathing) or aesthetic, and whether your body tends to form raised scars—these are decisions that cannot be made in an article.
Most questions that arise from searching "adolescent septal extension" can be clarified in a 15-minute in-person consultation.This is not a place where we push treatments on you. It's perfectly fine to listen and leave. Consultations are free.
If you have any concerns, please feel free to consult with us. We will distinguish between information that is necessary and information that is not, tailored to each person's situation.
References
- Bernstein L.. Early Submucous Resection of Nasal Septal Cartilage: A Pilot Study in Canine Pups. Archives of Otolaryngology - Head and Neck Surgery. 1973https://doi.org/10.1001/archotol.1973.00780010281012
- Coleman William P.. FAT TRANSPLANTATION. Dermatologic Clinics. 1999https://doi.org/10.1016/s0733-8635(05)70136-4
- POLLACK SHELDON V., GOSLEN J. BLAKE. The Surgical Treatment of Keloids. The Journal of Dermatologic Surgery and Oncology. 1982https://doi.org/10.1111/j.1524-4725.1982.tb01092.x