Journal archive · Rib, ear and septal grafts · Nasal tip · Septum, valve and airway · Outcomes, satisfaction and psychology · Anatomy and nasal analysis · 2026
Comparative Outcomes of Septal Extension versus Columellar Strut Grafts for Nasal Tip Stabilization and Positioning in Rhinoplasty: A Systematic Review and Meta-analysis
Ozgenc I, Alzoubi D, Vankayalapati DK, Bayan LA, Lee SC, Huynh K, Waqasi A, Nakanishi H, Navaratnam AV.
What this paper says
Pooling eight studies with 627 patients, septal extension grafts gave a better long-term nasolabial angle than columellar struts and improved Goode's ratio after surgery, which struts did not.
Overview
The columellar strut graft (CSG) and septal extension graft (SEG) are the two common ways to support the nasal tip. The authors searched databases to August 2024 for studies of primary septorhinoplasty patients aged 17 or over receiving either graft, and ran a random-effects meta-analysis of the nasolabial angle (NLA) and Goode's ratio. The review was registered in PROSPERO (CRD42024574909).
Sections of note
- Eight studies met criteria: 256 CSG patients and 371 SEG patients.
- Long-term postoperative NLA favoured SEG (p < 0.05).
- Goode's ratio did not differ between groups at follow-up.
- SEG patients showed significant improvement in Goode's ratio from before to after surgery (p < 0.05); CSG patients did not.
- The authors conclude SEG "may provide superior long-term" rotation and projection stability.
What it means for a patient
- Across the pooled studies, the extension graft held tip rotation better over time than the strut.
- Projection ratios ended up similar, though only the SEG group improved from baseline.
- The two grafts have different feel: SEG fixes the tip rigidly; a strut leaves some movement. This trade-off is not measured here.
Why this paper matters
It is a registered meta-analysis on a long-debated choice. Limits: eight mostly observational studies, unstated heterogeneity, and no data on complications or tip stiffness.
Terms
- Nasolabial angle (NLA): the angle between the upper lip and the columella; a measure of tip rotation.
- Goode's ratio: tip projection divided by nasal length.
- Random-effects model: a pooling method that allows for differences between studies.
- PROSPERO: an international register of systematic reviews.
Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows. All 1,262 summaries.
From the abstract
“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…”
Excerpt; the full abstract is on PubMed.
Citation
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What the rhinoplasty literature says on this paper's topics, cited line by line to PubMed.
Rib, ear and septal grafts
Modern rhinoplasty builds rather than removes, so the operation runs on cartilage: the septum first, then the ear, then the rib, and when none of those will do, a piece of donated rib from a tissue bank.
Nasal tip
Tip surgery is now a support problem rather than a sculpting problem: the septal extension graft holds projection and rotation where the columellar strut loses them (0.2% against 4.7% projection loss at one year), and the current series repair, reposition and reinforce the lower lateral cartilages instead of excising them.
Septum, valve and airway
Every rhinoplasty is a breathing operation whether it intends to be or not: the septum holds the nose up as well as dividing it, and the narrowest part of the whole airway is the internal valve the surgeon is standing over.
Outcomes, satisfaction and psychology
Rhinoplasty is measured with ten different questionnaires, none of which covers both the way the nose looks and the way it breathes, and the best-developed one has no airway questions at all.
Anatomy and nasal analysis
Before any technique is chosen, the nose has to be read: the bone measured, the cartilage counted, the skin assessed, and the result the patient wants agreed on a photograph that is not yet true.
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