Enhancing Nasal Tip Control: The Role of Septum Anchorage Sutures in Modern Rhinoplasty

Abstract

Introduction

The septocolumellar suture technique has shown consistent efficacy in achieving precise nasal tip aesthetics for over 20 years. This study aims to evaluate the long-term outcomes of primary endonasal rhinoplasty.

Methods

Retrospectively analyze 1,096 consecutive patients who underwent primary endonasal rhinoplasty using the septocolumellar suture technique between March 2005 and March 2025. The procedure anchors the medial crura to the caudal septum at variable distances from the anterior nasal spine, allowing control of tip projection and rotation. Objective and photographic analyses assessed the nasal tip parameters, including projection, rotation, shape, deviation, alar width, and flare. Statistical significance was set at p < 0.001.

Results

Long-term stability of nasal tip projection and rotation was maintained in 96% of the patients at a minimum 12-month follow-up. All the evaluated parameters demonstrated statistically significant improvement (p < 0.001). The revision and complication rates were 3.2 and <1%, respectively.

Conclusion

The septocolumellar suture technique is a reliable and minimally invasive method for nasal tip refinement in rhinoplasty. It ensures stable aesthetic outcomes while preserving nasal support and functional integrity. This technique effectively enhances tip projection in mestizo patients using intrinsic anatomy and can be applied in both open and closed approaches.

Keywords

septocolumelar suture - nasal tip positioning - nasal tip preservation - rhinoplasty - medial crura - caudal septum - nasal tip projection

Declaration of GenAI Use

In the preparation of this article, generative artificial intelligence (AI) tools were used to aid in the composition and linguistic refinement of “Introduction” and “Discussion” sections. Specifically, ChatGPT (OpenAI, GPT-4, accessed May 20, 2025) was employed to enhance grammatical accuracy and readability in English. An example prompt used was: “Improve the flow and clarity of this paragraph discussing the indications for septocolumellar suture.” No AI tool was employed for the data analysis, figure generation, or derivation of scientific conclusions. The authors reviewed and edited all the AI-assisted outputs to ensure accuracy and integrity. Potential limitations include the risk of subtle contextual misinterpretation by AI, which was mitigated through a comprehensive manual revision. The authors have reviewed and edited the text and take full responsibility for the content of the article.

Data Availability Statement

All relevant data supporting the findings of this study are contained in the article and its supplementary materials. Additional anonymized datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.

Ethical Approval

This study was conducted in compliance with the Declaration of Helsinki and local ethical guidelines. All participants provided informed consent, permitting the use of anonymized clinical data and images for academic publication.

Publication History

Received: 29 October 2025

Accepted: 14 December 2025

Accepted Manuscript online:
19 December 2025

Article published online:
08 January 2026

• References

• 1 Anderson JR. A new approach to rhinoplasty. Arch Otolaryngol 1966; 83 (02) 135-139
• 2 Tardy ME. et al. The tripod concept in tip surgery. Facial Plast Surg 1987; 4 (01) 45-50
• 3 Tebbetts JB. Shaping and positioning the nasal tip without structural disruption: a new, systematic approach. Plast Reconstr Surg 1994; 94 (01) 61-77
• 4 Guyuron B. Dynamics in rhinoplasty. Plast Reconstr Surg 2000; 105 (06) 2257-2259
• 5 Daniel RK. Rhinoplasty: the first 100 years. Aesthet Surg J 2002; 22 (01) 33-38
• 6 Daniel RK. New concepts in nasal tip contouring. Plast Reconstr Surg 2006; 117 (02) 373-392
• 7 Tezel E, Numanoğlu A. Septocolumellar suture in closed rhinoplasty. Ann Plast Surg 2007; 59 (03) 268-272
• 8 Gfrerer L, Riesel JN, Bartlett RA. Nasal tip delamination: a technique for nasal tip projection and control in rhinoplasty. Plast Reconstr Surg Glob Open 2020; 8 (10) e3195
• 9 Murtaza G, Syed SH, Sarwar MM. et al. Septocolumellar suture technique for correction of septal caudal dislocation. J Rawalpindi Med Coll 2021; 25 (04) 564-569
• 10 Dehghani N, Mahmoudi X, Azarsina M, Hosseini E. Columella-labial angle changes following septocolumellar suture and lateral crural overlay methods in rhinoplasty. World J Plast Surg 2025; 14 (02) 92-97
• 11 Neves JC, Rijo-Cedeño J, Teixeira Rodrigues JL. et al. The fusion sling-revisiting the nasal tip suspensory anatomy. Facial Plast Surg Clin North Am 2025; 33 (02) 143-157
• 12 Toriumi DM. New concepts in nasal tip contouring. Arch Facial Plast Surg 2012; 14 (03) 193-206
• 13 Daniel RK. The nasal tip: anatomy and aesthetics. Arch Facial Plast Surg 2013; 15 (03) 171-180
• 14 Çakır B, Genç B, Finocchi V, Haack S. My approach to preservation rhinoplasty. Facial Plast Surg Clin North Am 2023; 31 (01) 25-43
• 15 Lo S, Rowe-Jones J. Suture techniques in nasal tip sculpture: current concepts. J Laryngol Rhinol Otol 2007; 121 (08) e10
• 16 Gassner HG. Structural grafts and suture techniques in functional and aesthetic rhinoplasty manipulation of the cartilaginous skeleton through suture techniques. Current Topics in Otorhinolaryngology. Head Neck Surg 2010; 9: 1-19
• 17 Espinosa J, Solis L, Cobo R, Heredia N, Ochoa J. Septocolumelar suture technique as nasal tip positioning and preservation method (D. Corredor, Trad.). Medvix Publ 2025; 1 (01) 1
• 18 Bayrak SB, Penn J, Hu J, David Kriet J, Humphrey CD. Validation of the modified rhinoplasty assessment scale (photographic). Ann Otol Rhinol Laryngol 2022; 131 (11) 1247-1251
• 19 Sharp HR, Rowe-Jones JM. Assessing outcome in aesthetic rhinoplasty. Clin Otolaryngol Allied Sci 2003; 28 (05) 430-435
• 20 Rosi-Schumacher M, Sherris DA. Outcomes following rhinoplasty using the combined septal extension-columellar strut graft. Facial Plast Surg Aesthet Med 2024; 26 (06) 769-774
• 21 García Espinosa F, García Jaramillo MV. Técnica personal para el manejo quirúrgico de la punta nasal en la cirugía plástica de la nariz. Otorhinolaryngol Cirugía Cabeza Cuello 1999; 27 (02) 26-29
• 22 Bernardo Rojas R. El manejo de la punta nasal básica. Otorhinolaryngol Cirugía Cabeza Cuello 1999; 27 (03) 26-29
• 23 Pedroza F. A 20-year review of the “new domes” technique for refining the drooping nasal tip. Arch Facial Plast Surg 2002; 4 (03) 157-163
• 24 Espinosa-Reyes JA, Solis-Ruiz LA. (2020). Overprojected Nasal Tip: Technique To Decrease The Nasal Tip Projection. Rhinoplasty Archive;
• 25 Abdelkader R, El-Noamany S, Makarem K. Rotating the tip in long noses: a strategy rather than a single technique. Plast Reconstr Surg Glob Open 2021; 9 (06) e3629
• 26 Çelik V, Tuluy Y, Bozkurt GÇ. Tip surgery in dorsal preservation rhinoplasty: the effect of modified low septal strip septoplasty on tip plasty. Aesthetic Plast Surg 2024;
• 27 Apaydin F. Projection and deprojection techniques in rhinoplasty. Clin Plast Surg 2016; 43 (01) 151-168
• 28 Nocini R, Magagnotto N, Chirumbolo S, Albanese M, Bertossi D. New insights into the role of columellar strut and septal extension graft: a comparative review of long-term outcomes. Diagnostics (Basel) 2025; 15 (16) 2051
• 29 Adamu A, Kirfi AM, Shofoluwe NA, Shuaibu IY, Nwaorgu OGB. Nasal columella reconstruction using philtrum advancement flap: a case report of treatment of nasal stenosis. Egypt J Otolaryngol 2023; 39 (01)
• 30 Tezel E, Ersoy B. Tip-oriented closed rhinoplasty built on septocolumellar suture and a new caudal septal graft technique. Ann Plast Surg 2016; 77 (03) 264-271
• 31 Valdivia C, Durand PD, Çakir B. Closed preservation rhinoplasty in the mestizo patient: challenges and techniques for nasal tip support. Aesthet Surg J 2025; 45 (06) 568-573
• 32 Facs ASFM, Samra S. Nuances associated with Septocolumellar sutures. Rhinoplasty Archive; . Accessed April 29, 2020 at: https://www.rhinoplastyarchive.com/articles/nasal-tip-aesthetics/nuances-associated-with-septocolumellar-sutures?utm_source=chatgpt.com
• 33 Hosokawa Y, Miyawaki T, Akutsu T. et al. Effectiveness of modified cutting and suture technique for endonasal caudal septoplasty in correcting nasal obstruction and preventing nasal tip projection loss. J Otolaryngol Head Neck Surg 2021; 50 (01) 35
• 34 Omer GL, Şeneldir S, Di Girolamo S. et al. Süreyya-Dani technique, a new technique to address notching of soft triangle and opening external nasal valve. Front Surg 2024; 11: 1385016
• 35 Daniel RK. Rhinoplasty: a simplified, three-stitch, open tip suture technique. Part I: primary rhinoplasty. Plast Reconstr Surg 1999; 103 (05) 1491-1502
• 36 Gruber RP. Suture techniques. In: Gunter JP, Rohrich RD, Adams Jr WP. eds. Dallas Rhinoplasty. St. Louis, Mo: Quality Medical Publishing, Inc; 2002: 254-270
• 37 Jorge A, Espinosa R, Palacio M. La punta nasal, determinantes quirúrgicos. Otorhinolaryngol Cirugía Cabeza Cuello 1999; 27 (02) 26-29