Does Laterality of the Caudal Septal Extension Graft Matter? A Photograph-Based Analysis of Symmetry in Rhinoplasty

McCleary S, Khan A, Khetpal S, Cascavita CT, Rezzadeh K, Nahabet E, Wolfe EM, Klomhaus A, Roostaeian J.

What this paper says

In 122 patients followed for an average of 18 months, whether the septal extension graft was placed on the left or right of the septum made no measurable difference to tip symmetry.

Overview

Caudal septal extension grafts are usually fixed to one side of the septum, and surgeons have debated whether that side shifts the tip. The UCLA authors reviewed septorhinoplasty patients from 2014 to 2021 who received the graft, extracted frontal, basal, top-down and lateral photographs before and one year after surgery, and had two independent evaluators score tip symmetry from -100 to +100. Two statistical models were run.

Sections of note

122 patients; mean follow-up 18 months.
Graft laterality had no statistically significant effect on tip symmetry in any view, by both ANOVA and linear mixed-effects models.
The authors conclude symmetry depends on "a midline and straight septum" rather than graft side.
Future work is proposed using AI for objective symmetry scoring.

What it means for a patient

Which side the surgeon attaches the tip graft to is not a determinant of a straight tip in this study.
A straight, centred septum is what matters; a crooked septum should be fixed first.
Symmetry was judged by human raters on photographs, which has limits.

Why this paper matters

It settles a practical question surgeons argue about, with a reasonable sample and multi-view assessment. Limits: retrospective, subjective scoring, single centre.

Terms

Caudal septal extension graft (CSEG): cartilage sutured to the front of the septum to set tip position.
Laterality: which side of the septum the graft is placed on.
Linear mixed-effects model: a statistical method accounting for repeated measures per patient.
Basal view: the photograph taken from below, looking up at the nostrils.

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

From the abstract

“Ideal tip projection and rotation in rhinoplasty often requires placement of caudal septal extension grafts (CSEGs). Although CSEGs are ubiquitous in rhinoplasty, there remains a lack of consensus on how laterality of placement may impact symmetry over time. This study aimed to objectively assess symmetry of the tip…”

Excerpt; the full abstract is on PubMed.