Evaluating the Role of Columellar Strut Grafts in the ERA of Septal Extension in Preservation Rhinoplasty

Ishida LC, Daronch OT, Ouchi JK, Gemperli R.

PubMed 41345307 Publisher (DOI)Free full text (PMC)

What this paper says

In a 38-patient series, both columellar strut and septal extension grafts held the tip at one year, and the senior author chose the strut in 29 cases for a more natural, mobile tip.

Overview

The authors reviewed 38 patients to compare when a columellar strut graft (CSG) and a septal extension graft (SEG) were used and how the tip held up. Follow-up was one year, judged by photographic comparison and patient satisfaction. Both grafts gave satisfactory results; the strut was the senior author's default.

Sections of note

29 of 38 patients received a columellar strut; 9 received a septal extension graft.
SEG was chosen for patients with a poorly projected nasal spine or a need for more septal support, described as common in certain ethnic groups.
Both techniques maintained projection and rotation at one year on photographs.
The stated advantage of the strut is "more predictable nasal aging" and preserved tip mobility.
Level of Evidence IV.

What it means for a patient

The strut, an older technique, remains a reasonable choice for tip support; it is not obsolete.
In this series the choice depended on anatomy: weak nasal spine or short septum favoured the extension graft.
A strut leaves the tip slightly mobile; an extension graft fixes it more rigidly.
The conclusions are the senior author's opinion from a small series, not a controlled comparison.

Why this paper matters

It argues against the trend of using septal extension grafts by default, from a Brazilian academic group. Limits: retrospective, 38 patients, unequal groups, subjective photographic assessment.

Terms

Columellar strut graft (CSG): a cartilage post between the tip cartilages, not attached to the septum.
Septal extension graft (SEG): a cartilage extension fixed to the septum that the tip cartilages are sutured to.
Nasal spine: the small bony point at the base of the septum above the upper lip.
Tip mobility: how much the tip moves when pressed; rigid tips can look and feel unnatural.

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

Abstract

Background: The columellar strut (CSG) was developed at the start of rhinoplasty to rebuild the nasal tip's projection and ligaments. In an effort to offer more tip assistance, the septal extension graft (SEG) surfaced as a substitute. Today, both techniques can be used and are performed by almost all rhinoplasty surgeons.

Methods: A retrospective case study of 38 patients that evaluated the indication and results of CSG and SEG after one year of follow-up to observe maintenance of projection and rotation of the nasal tip based on photographic comparison and patient satisfaction.

Results: Both CSG and SEG produce satisfactory results. Although the SEG was well advised in certain ethnic patient instances with a poorly projected nasal spine or a requirement for more septal support (n = 9), the columellar strut is chosen in the majority of the senior author's cases due to the natural results (n = 29) as a specialist opinion.

Conclusions: The columellar strut is still quite useful in rhinoplasty. Its key benefit, according to the senior's author experience, is that it allows for more predictable nasal aging and provides a natural nose while preserving tip mobility.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).