Superiority of the Septal Extension Graft over the Columellar Strut Graft in Primary Rhinoplasty: Improved Long-Term Tip Stability

Bellamy JL, Rohrich RJ.

What this paper says

Comparing 37 patients with a septal extension graft against 40 with a columellar strut, tip projection loss at one year was 0.2 percent with the extension graft versus 4.7 percent with the strut.

Overview

Both grafts are used to hold the nasal tip in position after rhinoplasty, and which holds better has been debated. The authors reviewed all primary open rhinoplasties by one senior surgeon from 2016 to 2019, keeping adults with at least a year of follow up and excluding revision cases and cases using rib grafts. Standardized photographs at 2 months and 12 months were measured for change in tip projection and rotation.

Sections of note

Design: retrospective comparative review, single senior surgeon. Level of evidence therapeutic III.
The chart query returned 133 patients; 40 had a columellar strut and 37 had a septal extension graft.
Projection loss at one year: 4.7 percent for the strut group versus 0.2 percent for the extension graft group, p less than 0.0001.
Multivariable analysis showed a 5.1 fold increased risk of losing more than 4 percent of projection with a columellar strut, p less than 0.005.
Mean rotation loss: 4.9 degrees for the strut group versus 1.3 degrees for the extension graft group, p less than 0.0001, with a 2.8 fold increased risk of losing 5 degrees or more.

What it means for a patient

A septal extension graft, which anchors the tip to the septum, held tip position far better over the first year than a strut placed between the nostrils.
Some drop and derotation should be expected with a columellar strut alone, and can be planned for by slightly overcorrecting.
Limits: retrospective, one surgeon, no randomization, follow up only to 12 months, and 77 of 133 identified patients fell into the two compared groups.

Why this paper matters

Loss of tip projection over time is a recurring reason noses look different a year after surgery than at the first postoperative visit. This study puts measured numbers on the difference between the two standard support grafts. It does not report breathing outcomes, satisfaction, or results beyond one year.

Terms

Septal extension graft: cartilage fixed to the septum that carries the tip in a set position.
Columellar strut: a cartilage post placed between the nostrils to support the tip.
Tip projection: how far the tip stands out from the plane of the face.
Tip rotation: the upward or downward angle of the tip.

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

From the abstract

“Columellar strut grafts and septal extension grafts are commonly used support structures; however, their relative effectiveness remains debated. The purpose of this study was to compare the long-term stability of septal extension grafts to that of columellar strut grafts. Methods: A retrospective review of all primary…”

Excerpt; the full abstract is on PubMed.