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In Reply We appreciate the kind words from Dr Xavier regarding our article1 and would like to elaborate on some of the statements in his letter. Dr Xavier comments on the Cakmak algorithm’s type 4 deformity and suggests addressing these patients similarly to those with type 3a and type 3b deformities (using an L-strut affixed to holes drilled in the nasal bones), plus using a nonstructural graft, such as diced cartilage in fascia or diced cartilage with fibrin glue placed along the nasal dorsum, from the radix to the supratip area. We would like to emphasize that our main goal in saddle nose reconstruction is first and foremost to reconstruct a more projected, widened, and strengthened dorsal septum for the nasal skeleton to sit on and to continue to reconstruct from there when possible. The Cakmak algorithm enables functional improvement by restoring the ideal strength and height of the septal skeleton, reestablishing ideal connections between the upper lateral and dorsal septal cartilages, and correcting nasal valve angles as well as producing a positive aesthetic result.
Cakmak O, Emre IE, Ozkurt FE. Addressing Saddle Nose Deformity—Reply. JAMA Facial Plast Surg. 2016;18(1):75-76. doi:10.1001/jamafacial.2015.1864