Comparative Outcomes of Septal Extension versus Columellar Strut Grafts for Nasal Tip Stabilization and Positioning in Rhinoplasty: A Systematic Review and Meta-analysis

Ozgenc I, Alzoubi D, Vankayalapati DK, Bayan LA, Lee SC, Huynh K, Waqasi A, Nakanishi H, Navaratnam AV.

PubMed 40854551 Publisher (DOI)

What this paper says

Pooling eight studies with 627 patients, septal extension grafts gave a better long-term nasolabial angle than columellar struts and improved Goode's ratio after surgery, which struts did not.

Overview

The columellar strut graft (CSG) and septal extension graft (SEG) are the two common ways to support the nasal tip. The authors searched databases to August 2024 for studies of primary septorhinoplasty patients aged 17 or over receiving either graft, and ran a random-effects meta-analysis of the nasolabial angle (NLA) and Goode's ratio. The review was registered in PROSPERO (CRD42024574909).

Sections of note

Eight studies met criteria: 256 CSG patients and 371 SEG patients.
Long-term postoperative NLA favoured SEG (p < 0.05).
Goode's ratio did not differ between groups at follow-up.
SEG patients showed significant improvement in Goode's ratio from before to after surgery (p < 0.05); CSG patients did not.
The authors conclude SEG "may provide superior long-term" rotation and projection stability.

What it means for a patient

Across the pooled studies, the extension graft held tip rotation better over time than the strut.
Projection ratios ended up similar, though only the SEG group improved from baseline.
The two grafts have different feel: SEG fixes the tip rigidly; a strut leaves some movement. This trade-off is not measured here.

Why this paper matters

It is a registered meta-analysis on a long-debated choice. Limits: eight mostly observational studies, unstated heterogeneity, and no data on complications or tip stiffness.

Terms

Nasolabial angle (NLA): the angle between the upper lip and the columella; a measure of tip rotation.
Goode's ratio: tip projection divided by nasal length.
Random-effects model: a pooling method that allows for differences between studies.
PROSPERO: an international register of systematic reviews.

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

From the abstract

“Columellar strut graft (CSG) and septal extension graft (SEG) are commonly used in septorhinoplasty for nasal tip support. Objective And Hypotheses: We aimed to systematically review and compare CSG and SEG in achieving a desired nasolabial angle (NLA) and Goode's ratio (GR). Study Design: Several databases were…”

Excerpt; the full abstract is on PubMed.