Preserving Nasal Tip Rotation and Projection in Open Septorhinoplasty

Background: Open septorhinoplasty is a common facial plastic surgery procedure that requires extensive planning and knowledge to achieve predictable outcomes. Many patients want to keep their nasal tip characteristics, and the surgeon's task is to reliably meet this expectation and provide stable long-term results. Techniques used to reconstruct nasal tip support include the tongue-in-groove, caudal septal extension graft, and caudal septal replacement graft procedures. Methods: We assessed the 1-year reliability of tongue-in-groove, caudal septal extension graft, and caudal septal replacement graft procedures in maintaining nasal tip rotation and projection in open septorhinoplasty. We conducted a retrospective case series review of septorhinoplasty cases between 2015 and 2019 at the Medical University of South Carolina. Cases with intention to change nasal tip rotation or projection were excluded. Two blinded reviewers analyzed standardized preoperative and 1-year postoperative photographs. Results: Fifty-seven patients fit the inclusion criteria and were included in the analysis. Mean preoperative and postoperative nasal tip rotations and projection ratios were similar (P=0.62, P=0.22, respectively). Twenty-six patients underwent a tongue-in-groove procedure, 24 had a caudal septal extension graft, and 7 had a caudal septal replacement graft with preoperative nasal tip rotations of 98.93°, 99.35°, and 96.89°, respectively (P=0.73). At 1 year, patients who received a tongue-in-groove procedure had a significant increase in nasal tip rotation to 101.24° (P=0.013), while patients who received a caudal septal extension graft had a significant decrease in nasal tip rotation to 97.25° (P=0.009). Patients who received a caudal septal replacement graft had no significant change in nasal tip rotation (P=0.117). The preoperative and postoperative projection ratios were not significantly different among the 3 techniques. Conclusion: Tongue-in-groove, caudal septal extension graft, and caudal septal replacement graft are reliable techniques for maintaining nasal tip projection in open septorhinoplasty. In our experience, when attempting to maintain preoperative nasal tip rotation, the tongue-in-groove technique resulted in a significant increase in tip rotation of 2.31°, while the caudal septal extension graft resulted in a significant decrease of 2.1° at 1 year postoperatively.