Nasal Tip Flexibility and Stability: Comparison of Septal Extension Grafts and Columellar Strut Grafts in a Prospective Trial

Abstract

Background: The stability of nasal tip rotation and projection, as well as providing a flexible nasal tip, are important elements in rhinoplasty. Two common options to provide these requirements are the septal extension graft (SEG) and the columellar strut graft (CSG). This study aims to compare the nasal tip stability and flexibility between the two graft options. Methods: A prospective randomized study was carried out on sixty patients operated on with either the CSG or SEG. Tip rotation and projection stability were analyzed with photographic evaluation at the immediate postoperative period, the first month and the first year. Nasal tip flexibility was evaluated with a Newton meter at the preoperative period and postoperative first, third, and sixth months and the first year. Results: The CSG showed a significant loss of projection and rotation, while the SEG showed better preservation of projection and rotation. However, both options showed a greater loss of projection and rotation in the first month and then a slight decrease in the following months. Although the SEG had lesser flexibility compared to the CSG anteroposteriorly, there was no flexibility difference between them in the lateral direction in the long term. Conclusion: The SEG provides better nasal tip stability compared to the CSG. The biggest downside of the SEG is decreased flexibility compared to the CSG. Surgeons should be aware of the loss of projection and rotation with both graft options and adjust their operation plan according to these points.