Columellar strut grafts versus septal extension grafts – which is better?
Reviewed by Shivanchan Rajmohan

Rhinoplasty is a commonly performed procedure that, while often pursued for cosmetic enhancement, can also significantly influence nasal airway function. This seven year retrospective cohort study performed at a tertiary centre in Australia compares two well established techniques for nasal tip support in rhinoplasty – columellar strut grafts (CSG) and septal extension grafts (SEG). From a total of 165 patients who underwent open rhinoplasty, postoperative objective outcomes (nasal tip projection, nasal peak inspiratory flow, nasal airway resistance, tip support using nasolabial angle and Simon’s ratio) and subjective outcomes (nasal obstruction and cosmesis satisfaction using visual analogue scale, nose outcome symptom evaluation (NOSE) were evaluated. Both primary and revision rhinoplasties for cosmetic and functional indications were included in this study. Overall, both SEG and CSG groups displayed statistically equivalent improvement in airway function, nasal obstruction and NOSE scores. Noteworthy is the statistically significant superior cosmetic scores with SEG with photographic analysis demonstrating superior maintenance of tip projection and nasolabial angle in the SEG cohort. Whilst both techniques preserve or improve nasal airway function, SEG demonstrates a significant aesthetic edge at 12 months providing durable structural support against tip deprojection and nasolabial angle distortion. One should however note the higher proportion of revision rhinoplasties within the CSG group. The evolution of the CSG technique to include ligament preservation is important and it is possible more traditional non-ligament preserving CSG techniques were utilised in this study. Therefore, how do modern ligament-preserving CSG techniques compare with SEGs with regards to tip support and airway function?

Columellar strut grafts versus septal extension grafts during rhinoplasty for airway function, patient satisfaction and tip support.
Lathif A, Alvarado R, Kondo M, et al.
J PLAST RECONSTR AESTHET SURG
2022;75(7):2352–8.