Efficacy of Combined Septal Extension and Derotation Grafts in Asian Rhinoplasty: A Quantitative Analysis of Tip Projection and Stability

Huang CJ, Tsai TY, Yen CI, Chen HC, Chang CS, Hsiao YC.

PubMed 41990353 Publisher (DOI)

What this paper says

In 324 Asian patients with short noses, combining a septal extension graft with a derotation graft gave the most durable gains in nasal length and projection and the lowest revision rate (6.5% versus 10.6% and 14.3%).

Overview

Short-nose correction in Asian patients is hard because septal cartilage is weak, skin is thick and scar contraction pulls the tip back up. The authors compared three tip techniques in 324 patients operated by one surgeon from 2015 to 2022: derotation graft with columellar strut (DG + CS), septal extension graft alone (SEG), and SEG plus derotation graft (SEG + DG). Nasal length, projection and nasolabial angle were measured on lateral photographs, normalised to facial length, over more than 12 months.

Sections of note

SEG + DG showed the most consistent and durable gains in length and projection at every interval.
Long-term length and projection differed significantly across groups (P < .001), with both SEG groups beating DG + CS.
SEG + DG had the lowest variability.
Nasolabial angle differed overall (P = .009) but not after pairwise correction.
Revision rates: SEG + DG 6.5%, SEG only 10.6%, DG + CS 14.3%. Level of Evidence 3.

What it means for a patient

For lengthening a short Asian nose, anchoring the tip to a septal extension held better than a floating strut in this series.
Adding a derotation graft on top of the extension graft further improved stability and cut revisions.
Results come from one surgeon; other surgeons' techniques may differ.

Why this paper matters

It is a large quantified comparison of tip-support strategies for a specific and difficult indication. Limits: retrospective, single surgeon, technique choice not randomised.

Terms

Short nose: a nose with an upturned tip and reduced length, often after contraction.
Septal extension graft (SEG): cartilage fixed to the septum to push the tip forward or down.
Derotation graft: cartilage placed to rotate the tip downward and lengthen the nose.
Columellar strut: a floating cartilage post between the tip cartilages.
Nasolabial angle: the angle between upper lip and columella; larger means more upturned.

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

From the abstract

“Short nose correction in Asian rhinoplasty is challenging due to weak septal cartilage, thick skin envelopes, and strong postoperative contractile forces that compromise long-term tip stability. Objectives: This study aimed to quantitatively compare the long-term outcomes of 3 nasal tip-plasty techniques-derotation…”

Excerpt; the full abstract is on PubMed.