Optimizing Nasal Tip Position: A Systematic Review of Columellar Strut and Septal Extension Grafts

Nasal tip position is a crucial aspect of rhinoplasty. To stabilize and define the nasal tip, various cartilaginous grafts have been widely utilized. The purpose of this systematic review is to critically evaluate and compare 2 prevalent grafting techniques: columellar strut grafts (CSGs) and septal extension grafts (SEGs). This study aims to 1) review rhinoplasty studies directly comparing CSGs with SEGs, 2) examine variations in graft technique, and 3) compare their impact on nasal tip projection, rotation, and patient-reported outcomes.

A systematic review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines was conducted. Screening and full-text review were performed by 2 independent evaluators. Data collection included patient demographics, operative techniques, patient-reported outcomes, and anthropometric measures of projection, and rotation.

Ninety-three articles were identified and screened based on predetermined criteria, with 24 undergoing full-text review. Eight studies, involving 571 patients, were included in the final analysis. Of these, 54% (n = 310) underwent SEGs, while 46% (n = 261) underwent CSGs. Patient-reported outcomes were only available in 2 studies. Most studies reported short- and long-term measurements of tip projection and rotation; 1 study provided additional data on nasal tip stiffness.

This systematic review provides a comprehensive examination of SEGs and CSGs in open rhinoplasty. While SEGs have been shown to provide superior long-term tip stability, some authors contend that CSGs hold value for specific patients. We propose a patient-specific approach for selecting between CSGs versus SEGs based on existing comparative data.