A Comparative Study of Septal Extension Graft versus Derotation Graft for Short Nose Correction in Asian Rhinoplasty

Namgoong S, Yoon Y, Park S, Suh MK.

PubMed 39965161 Publisher (DOI)

What this paper says

Among 429 Asian tip-plasty patients with measurements, septal extension and derotation grafts both held tip projection over two or more years, but the extension graft caused more tip and columellar deviation (5.23% versus 1.41%) and the derotation graft more tip drooping (8.45% versus 4.53%) and supratip deformity (2.82% versus 0%).

Overview

Both grafts are used to lengthen and project the short Asian nose, but had not been compared. The Korean authors retrospectively analysed 729 tip-plasty patients treated between January 2011 and December 2017, assessed complications at a minimum of 6 months, and measured tip projection and columellar-labial angle by the Goode and Byrd methods in those with 24 months or more of follow-up.

Sections of note

Long-term measurements in 287 SEG and 142 DRG patients.
Both improved projection significantly: SEG Goode change 0.036 (P = 0.001); DRG Goode change 0.047 (P = 0.005).
No difference between techniques in projection ratio (Goode P = 0.954; Byrd P = 0.452) or columellar-labial angle (P = 0.116).
SEG: more tip-columellar deviation (5.23% versus 1.41%).
DRG: more tip drooping (8.45% versus 4.53%, adjusted P = 0.040) and supratip deformity (2.82% versus 0%, adjusted P = 0.010).
No difference in relapse of tip shortening. Level of Evidence III.

What it means for a patient

Both grafts lengthen the nose about equally and the result lasts two years or more.
Each has a characteristic failure: the extension graft can push the tip off-centre; the derotation graft can let it droop or leave a bump above the tip.
The authors advise choosing by anatomy and surgeon experience.

Why this paper matters

It is a large, long-follow-up head-to-head of the two main lengthening grafts in Asian rhinoplasty. Limits: retrospective, single centre, non-randomised technique selection.

Terms

Septal extension graft (SEG): cartilage fixed to the septum that the tip is sutured onto.
Derotation graft (DRG): cartilage placed to rotate the tip downward and lengthen the nose.
Columellar-labial angle: the angle between the columella and upper lip.
Supratip deformity: a bump just above the tip (also called pollybeak).
Goode and Byrd methods: two standard ways of measuring tip projection on photographs.

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

From the abstract

“Precise nasal tip refinement is a cornerstone of Asian rhinoplasty that addresses characteristics such as bulbous tips, short columellas, and flared nostrils. The septal extension graft (SEG) and the derotation graft (DRG) are commonly used to enhance tip projection; however, comparative analyses are lacking. The…”

Excerpt; the full abstract is on PubMed.