A Novel Modification of Tongue in Groove Technique (Auto-Septal Projection Graft) in Rhinoplasty

Koçak İ, Gökler O.

What this paper says

In 42 patients having a modified tongue in groove technique, the average nasolabial angle rose from 85.7 to 99.3 degrees and tip projection ratio from 0.60 to 0.64 at an average 17.3 months.

Overview

A drooping tip with a narrow angle between nose and lip makes the nose look long. Several techniques exist to lift such a tip, including caudal septal extension grafts, extended columellar struts, tongue in groove, columellar struts and rotation sutures. This study assessed changes in tip support after a modified tongue in groove technique the authors call the auto septal projection graft.

Sections of note

Retrospective analysis of 42 patients having primary open septorhinoplasty between June 2017 and March 2019; level of evidence IV.
Thirty three patients were female and 9 male.
Before and after photographs were analysed for nasolabial angle and tip projection ratio.
Mean follow up was 17.3 months.
Mean nasolabial angle was 85.7 degrees before surgery and 99.3 degrees after.
Tip projection ratio was 0.60 before and 0.64 after.
Both tip rotation and tip projection increased significantly, P less than 0.05.

What it means for a patient

The technique lifted the tip by about 14 degrees on average and increased its projection slightly.
Measurements came from photographs rather than direct measurement of the nose.
Forty two patients from one centre with no comparison group is limited evidence.
The abstract reports no complication rate and no patient satisfaction scores.

Why this paper matters

The droopy tip is one of the most common complaints in rhinoplasty and many competing techniques address it. This study measures one modification against its own baseline. Whether it holds tip position better than standard tongue in groove or a septal extension graft is not tested.

Terms

Tongue in groove: a technique sliding the tip cartilages onto the front edge of the septum to set tip position.
Nasolabial angle: the angle between the base of the nose and the upper lip.
Tip projection ratio: a measure of how far the tip stands out relative to nasal length.
Derotation: the tip rotating downward, making the nose look longer.
Columellar strut graft: a cartilage post between the nostrils supporting the tip.

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

From the abstract

“Derotation of the nasal tip with narrow nasolabial angle is a common nasal deformity that leads to a long nose appearance, named drooping nose. In these patients, there are various techniques described to fix droopy tip and to achieve a desirable nasal tip rotation such as caudal septal extension graft, extended…”

Excerpt; the full abstract is on PubMed.