**4. Dissection of the nose**

We make an inverted V incision along the midcolumella, which is connected with bilateral marginal incisions. The skin flap is elevated to the level of perichondrium of the lower lateral cartilage. We use tenotomy scissors and elevators for this step. In presence of excess subcutaneous tissue in thick skin clients, it may be removed (but not aggressively) for more post operative tip definition. Septum is approached by separating the two medial crura and the subperichondrial plane of the caudal septum is identified. The septum is exposed by elevating bilateral mucoperichondrial flaps and separated from the upper lateral cartilage. A dorsal-caudal L-shaped strut of the septum is preserved for septal support. This harvested septal graft may be used as caudal septal extension graft (CSEG) or splint grafts, but they may be deficient in revision cases.
