Comparative Outcomes of Septal Extension versus Columellar Strut Grafts for Nasal Tip Stabilization and Positioning in Rhinoplasty: A Systematic Review and Meta-analysis

Abstract

Introduction

Columellar strut graft (CSG) and septal extension graft (SEG) are commonly used in septorhinoplasty for nasal tip support.

Objective and Hypotheses

We aimed to systematically review and compare CSG and SEG in achieving a desired nasolabial angle (NLA) and Goode's ratio (GR).

Study Design

Several databases were systematically searched from inception to August 2024. A two-arm meta-analysis of the pooled means was conducted with a random-effects model. This review was registered in PROSPERO (CRD42024574909).

Methods

Eligible studies included primary septorhinoplasty patients (≥17 years) receiving CSG or SEG.

Results

Eight studies met eligibility criteria including 256 CSG and 371 SEG patients. Intergroup comparison of long-term postoperative NLA favored SEG (p < 0.05) while GR showed no differences. However, SEG patients had significant improvement in GR postoperatively (p < 0.05), unlike CSG patients.

Conclusion

SEG may provide superior long-term nasal tip rotation and projection stability.

Keywords

rhinoplasty - septal extension graft - meta-analysis - columellar strut - septorhinoplasty

Publication History

Received: 02 June 2025

Accepted: 23 August 2025

Accepted Manuscript online:
25 August 2025

Article published online:
08 September 2025

• References

• 1 Lalezari S, Daar DA, Mathew PJ, Mowlds DS, Paydar KZ, Wirth GA. Trends in rhinoplasty research: a 20-year bibliometric analysis. Aesthetic Plast Surg 2018; 42 (04) 1071-1084
• 2 Gutowski KS, Chwa ES, Weissman JP. et al. Practice profile of practicing plastic surgeons: a 20-year review of plastic surgery statistics. Plast Reconstr Surg Glob Open 2023; 11 (12) e5486
• 3 Mandavia R, Parmar D, Ahmed MN. et al; EAFPS Rhinoplasty Research Network. An overview of rhinoplasty practices: European Academy of Facial Plastic Surgery, collaborative cross-sectional study. Facial Plast Surg 2024; 40 (01) 31-35
• 4 Eitner E. Kosmetische Operationen. Wien: Springer Editor; 1932
• 5 Baum SJ. Nasal projection. Arch Otolaryngol 1977; 103 (05) 262-267
• 6 Gandy JR, Manuel CT, Leary RP, Wong BJ. Quantifying optimal columellar strut dimensions for nasal tip stabilization after rhinoplasty via finite element analysis. JAMA Facial Plast Surg 2016; 18 (03) 194-200
• 7 Bellamy JL, Rohrich RJ. Superiority of the septal extension graft over the columellar strut graft in primary rhinoplasty: improved long-term tip stability. Plast Reconstr Surg 2023; 152 (02) 332-339
• 8 Byrd HS, Andochick S, Copit S, Walton KG. Septal extension grafts: a method of controlling tip projection shape. Plast Reconstr Surg 1997; 100 (04) 999-1010
• 9 Kucukguven A, Çelik M, Altunal SK, Kocer U. Nasal tip flexibility and stability: comparison of septal extension grafts and columellar strut grafts in a prospective trial. Plast Reconstr Surg 2024; 154 (02) 313-322
• 10 Patel PN, Abdelwahab M, Shukla ND. et al. Functional outcomes of septal extension grafting in aesthetic rhinoplasty: a cohort analysis. Facial Plast Surg Aesthet Med 2021; 23 (03) 172-179
• 11 Kim MH, Choi JH, Kim MS, Kim SK, Lee KC. An introduction to the septal extension graft. Arch Plast Surg 2014; 41 (01) 29-34
• 12 Rohrich RJ, Durand PD, Dayan E. Changing role of septal extension versus columellar grafts in modern rhinoplasty. Plast Reconstr Surg 2020; 145 (05) 927e-931e
• 13 Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6 (07) e1000097
• 14 Sterne JA, Hernán MA, Reeves BC. et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016; 355: i4919
• 15 Mantel N. Chi-square tests with one degree of freedom; extensions of the Mantel-Haenszel procedure. J Am Stat Assoc 1963; 58: 690-700
• 16 Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327 (7414) 557-560
• 17 Cumpston M, Li T, Page MJ. et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev 2019; 10 (10) ED000142
• 18 Sawh-Martinez R, Perkins K, Madari S, Steinbacher DM. Control of nasal tip position: quantitative assessment of columellar strut versus caudal septal extension graft. Plast Reconstr Surg 2019; 144 (05) 772e-780e
• 19 Akkus AM, Eryilmaz E, Guneren E. Comparison of the effects of columellar strut and septal extension grafts for tip support in rhinoplasty. Aesthetic Plast Surg 2013; 37 (04) 666-673
• 20 Aksakal C. Comparing the effects of tongue-in-groove and septocolumellar suture with short and floating columellar strut of open rhinoplasty on nasal tip rotation and projection. J Oral Maxillofac Surg 2021; 79 (02) 474.e1-474.e11
• 21 Demir UL. Comparison of tongue-in-groove and columellar strut on rotation and projection in droopy nasal tip: contribution of a cap graft. J Craniofac Surg 2018; 29 (03) 558-561
• 22 Erdal AI, Genç IG, Pasinlioğlu B, Findikçioğlu K. Flexible tongue-in-groove technique and its effectiveness compared to classic tongue-in-groove and columellar strut graft techniques: a retrospective analysis of 237 open rhinoplasty cases. Plast Reconstr Surg 2021; 148 (06) 1221-1232
• 23 Abdel Azeem KM, Ibrahim MF, ElShaer W, Atef M, Hawas E. Control of nasal tip position in thick skin population. columellar graft versus septal extension grafts in open rhinoplasty. Egypt J Plast Reconstr Surg. 2024; 48 (01) 73-78
• 24 Romero-Algara E, Navarro-Nuño DE, Romero-Algara E, Torres-Salazar QL. Superiority of the septal extension graft technique in rhinoplasty patient satisfaction versus the intercrural strut. Plast Surg (Oakv) 2024; 33 (03) 394-402
• 25 Atighechi S, Sajadinejad BS, Baradaranfar MH, Dadgarnia MH, Shahbazian H. Caudal extension graft versus columellar strut with plumping graft for acute nasolabial angle correction in rhinoplasty surgery. Eur Arch Otorhinolaryngol 2015; 272 (07) 1673-1677
• 26 Pedroza F, Santos EE, Espinosa F, Velásquez CJ, Gutiérrez AF, Serrano-Cruz EF. Association of nasal tip rotation outcome estimation with the new domes technique in primary rhinoplasty. JAMA Facial Plast Surg 2018; 20 (04) 292-299
• 27 Sajjadian A, Guyuron B. An algorithm for treatment of the drooping nose. Aesthet Surg J 2009; 29 (03) 199-206
• 28 Cobo R, Patrocinio LG, Guyuron B, Swanson M. Management of thick skin in rhinoplasty. Facial Plast Surg Clin North Am 2024; 32 (04) 473-493
• 29 Robinson S, Thornton M. Nasal tip projection: nuances in understanding, assessment, and modification. Facial Plast Surg 2012; 28 (02) 158-165
• 30 Ha RY, Byrd HS. Septal extension grafts revisited: 6-year experience in controlling nasal tip projection and shape. Plast Reconstr Surg 2003; 112 (07) 1929-1935
• 31 Peters RD, Vasudev M, Hakimi AA. et al. Boomerang modification of the septal extension graft: graft design and functional outcomes. Facial Plast Surg Aesthet Med 2024; 26 (04) 469-474
• 32 Karadavut Y, Akyıldız I, Karadaş H, Dinç AE, Tulacı G, Tastan E. Effectiveness of caudal septal extension graft application in endonasal septoplasty. Braz J Otorhinolaryngol 2017; 83 (01) 59-65
• 33 Rennie C, Saleh H. Assessment and the psychological aspects for septorhinoplasty. IJHNS 2018; 9: 38-45