Outcomes Following Rhinoplasty Using the Combined Septal Extension-Columellar Strut Graft

Overview

The two standard tip support grafts each have limitations, and the authors designed a single unit graft combining both. This study reports outcomes in patients treated between 2020 and 2022 with at least a year of follow up, using a blockage questionnaire before and after surgery plus standardized photographic assessment by independent reviewers.

Sections of note

• Design: retrospective analysis, 32 patients. Minimum 1 year follow up.
• Mean age 32.8 years; 96.9 percent female; 87.5 percent Caucasian.
• All were primary rhinoplasties: 68.8 percent cosmetic and 31.3 percent functional.
• Mean follow up 13.4 months, range 12 to 29.
• NOSE blockage scores fell from 34.4 to 4.84, p less than 0.001.
• Independent reviewers rated aesthetics as improved: mean 11.96 before surgery to 1.83 after, p less than 0.001.
• No loss of nasal tip support was observed.
• No revisions were required.

What it means for a patient

• Breathing scores dropped to near zero, though the starting average of 34.4 indicates mild to moderate blockage rather than severe.
• Photographs were rated by reviewers independent of the surgeon, which is a stronger method than surgeon self assessment.
• No patient lost tip support and none needed a second operation within the follow up period.
• Limits: 32 patients, single practice, retrospective, no comparison group against either graft used alone, and follow up averaging just over a year.

Why this paper matters

Loss of tip projection over time is a recognized late problem, and combining the two standard support grafts is one attempt to address it. Reporting no revisions and no loss of support at one year supports the design. Whether the combined graft outperforms either graft alone, or holds beyond a year, is untested.

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 from below.
• Nasal tip support: the structural resistance that keeps the tip from dropping.
• NOSE survey: a questionnaire measuring nasal blockage, where higher means worse.
• Primary rhinoplasty: a first nose operation, with no previous nasal surgery.