Measured gain in projection with the extended columellar strut-tip graft in endonasal rhinoplasty

Carron MA, Zoumalan RA, Pastorek NJ.

What this paper says

In 15 patients photographed a mean 32 months after closed rhinoplasty, an extended columellar strut-tip graft increased tip projection in every case, by a mean 19% (P < .05), showing the gain is real rather than an illusion.

Overview

The extended columellar strut-tip graft is a single piece of cartilage that runs up the columella and over the tip to add projection and definition. Critics suggested it only looks like it adds projection. The authors measured tip projection on matched before and after photographs to find out.

Sections of note

Retrospective case review of 15 patients, primary or revision rhinoplasty, over 10 years.
Follow-up photographs at a mean 32 months (range 8 months to 10 years).
Images cropped and sized equally; projection measured from the alar-facial crease to the tip-defining point.
Projection increased in all 15 patients; mean increase 19% over preoperative.
Statistically significant by paired t test (P < .05).
The effect was maintained years later; level of evidence 4.

What it means for a patient

This graft, placed through the closed approach, produced a measurable and lasting increase in how far the tip stands out.
Results held at nearly 3 years on average, with some patients followed to 10 years.
Only 15 patients, no comparison group, and photographic measurement can be affected by head position; complications are not reported in the abstract.

Why this paper matters

It supplies measured, long-term evidence for a graft used in endonasal rhinoplasty, where structural grafting is less documented than in open surgery. The small sample limits the precision of the 19% figure.

Terms

Extended columellar strut-tip graft: one cartilage piece running from between the tip cartilages up over the tip to add projection and definition.
Tip projection: how far the tip stands out from the face.
Endonasal rhinoplasty: rhinoplasty through incisions hidden inside the nostrils.
Alar-facial crease: the groove where the nostril meets the cheek, used as a measurement landmark.
Tip-defining point: the most forward point of the tip.
Paired t test: a statistical test comparing before and after measurements in the same patients.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“The extended columellar strut-tip graft was designed to improve nasal tip projection and tip definition in patients undergoing rhinoplasty. Objective: To determine whether the extended columellar tip graft leads to a true and measurable increase in nasal tip projection or simply gives the illusion of an increase in…”

Excerpt; the full abstract is on PubMed.