Comparison of Nasal Tip Projection and Rotational Stability between Structural Rhinoplasty with Strut Graft and Preservation Rhinoplasty with Pitanguy Ligament Graft

Farhadi F, Ahmadpour F, Nezafati S, Ahmadpour E, Sharifi A.

PubMed 42045684 Publisher (DOI)Free full text (PMC)

What this paper says

Over nine months, tip projection and rotation drifted downward equally whether the tip was supported by a columellar strut or a preserved Pitanguy ligament graft.

Overview

The authors asked whether a structural columellar strut or a preservation-style underlay Pitanguy ligament graft keeps the nasal tip in place better. Eighty-six primary rhinoplasty patients were split into two groups of 43. Tip projection and rotation were measured with 3D surface scans before surgery and at 3, 6 and 9 months. Both measures declined over time in both groups, with no difference between techniques.

Sections of note

Time significantly affected tip projection (P = 0.001), with both groups trending downward.
No between-technique difference in projection at 3, 6 or 9 months (P > 0.05).
Tip rotation followed the same pattern: a significant time effect (P = 0.001) and no time-by-group interaction (P = 0.285).
Measurements used 3D soft-tissue scanning rather than 2D photographs.
Level of Evidence III.

What it means for a patient

Some loss of tip projection and rotation in the first nine months is expected with either technique in this study.
In this study, the preservation-style ligament graft held the tip as well as a conventional strut.
Follow-up stopped at nine months; longer-term behaviour was not measured.

Why this paper matters

It is a prospective, equal-sized comparison using objective 3D scanning, addressing a common claim that ligament preservation gives less reliable tip support. Limits: 9-month follow-up, single-centre, and the abstract does not state randomisation.

Terms

Tip projection: how far the tip sits forward from the face.
Tip rotation: the upward or downward angle of the tip, often measured as the nasolabial angle.
Columellar strut: a cartilage post placed between the tip cartilages to hold the tip up.
Pitanguy ligament: a soft-tissue band running from the skin of the bridge to the tip cartilages; preservation surgeons keep or reattach it.
3D soft-tissue scan: a surface image of the face used to measure shape in three dimensions.

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

Abstract

Background And Aim: The nasal tip plays a central role in facial aesthetics, and achieving long-term tip stability is a key objective in rhinoplasty. This study compared postoperative tip stability between structural rhinoplasty using a strut graft (SG) and preservation rhinoplasty with an underlay Pitanguy ligament graft (PLG).

Method: Eighty-six primary rhinoplasty candidates were enrolled and divided into two groups of 43. One group received structural rhinoplasty with strut graft, while the other underwent preservation rhinoplasty with an underlay PLG. Nasal tip rotation and projection were measured using 3D soft tissue scans before surgery and at 3, 6, and 9 months postoperatively.

Results: Time significantly affected tip projection (P = 0.001) with both groups showing a downward trend, but no significant differences were observed between techniques at 3, 6, or 9 months (P > 0.05). Tip rotation showed a similar pattern; no significant differences between techniques at any time point. Repeated measures ANOVA confirmed a significant effect of time on rotation (P = 0.001) without a significant time-by-group interaction (P = 0.285).

Conclusion: Both structural rhinoplasty with SG and preservation rhinoplasty with underlay PLG yield similar outcomes in maintaining tip projection and rotation over 9 months. Time-dependent reductions were observed, but no statistically significant differences existed between techniques.

Level Of Evidence Iii: 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).