Graham Emily M, Huang Cynthia, Chung Kevin C
From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School.
Plast Reconstr Surg. 2025 Sep 1;156(3):349-355. doi: 10.1097/PRS.0000000000011703. Epub 2025 Aug 27.
: Precise nasal tip refinement is a cornerstone of Asian rhinoplasty that addresses characteristics such as bulbous tips, short columellas, and flared nostrils. The septal extension graft (SEG) and the derotation graft (DRG) are commonly used to enhance tip projection; however, comparative analyses are lacking. The authors assessed the outcomes of the SEG and the DRG in Asian patients who underwent tip-plasty.
: In this retrospective study, the authors analyzed 729 patients who underwent nasal tip-plasty using the SEG or the DRG between January of 2011 and December of 2017. Postoperative complications were assessed after a minimum follow-up of 6 months. For patients with long-term follow-up (≥24 months), nasal tip projection (NTP) and columellar-labial angle were measured preoperatively and postoperatively using the Goode and the Byrd methods.
: Among 287 SEG and 142 DRG cases, both techniques showed significant postoperative improvements: SEG (ΔNTP-Goode = 0.036, = 0.001; ΔNTP-Byrd = 0.036, < 0.001) and DRG (ΔNTP-Goode = 0.047, = 0.005; ΔNTP-Byrd = 0.053, < 0.001). No significant differences were noted for NTP ratios (Goode, = 0.954; Byrd, = 0.452) or columellar-labial angle ( = 0.116). Complications included more tip-columella deviations in the SEG group (5.23% versus 1.41%) and higher tip drooping (4.53% versus 8.45%; adjusted = 0.040) and supratip deformity (0% versus 2.82%; adjusted = 0.010) in the DRG group.
: Longitudinal analysis shows that both the SEG and the DRG effectively preserve tip projection over time. The SEG is more prone to tip and columellar deviations, whereas the DRG is associated with tip drooping and supratip deformity, with no difference in tip-shortening relapse. Technique selection should be customized to the patient’s anatomical features and the surgeon’s experience to minimize complications.
CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, III.
精确的鼻尖精细化整形是亚洲鼻整形术的基石，可解决诸如鼻尖圆钝、鼻小柱短小和鼻翼外扩等问题。鼻中隔延伸移植术（SEG）和去旋转移植术（DRG）常用于增加鼻尖突出度；然而，缺乏对比分析。作者评估了接受鼻尖整形术的亚洲患者中SEG和DRG的效果。
在这项回顾性研究中，作者分析了2011年1月至2017年12月期间接受使用SEG或DRG进行鼻尖整形术的729例患者。在至少随访6个月后评估术后并发症。对于长期随访（≥24个月）的患者，术前和术后使用古德（Goode）法和伯德（Byrd）法测量鼻尖突出度（NTP）和鼻小柱 - 唇角度。
在287例SEG和142例DRG病例中，两种技术均显示出显著的术后改善：SEG（ΔNTP - 古德法 = 0.036，P = 0.001；ΔNTP - 伯德法 = 0.036，P < 0.001）和DRG（ΔNTP - 古德法 = 0.047，P = 0.005；ΔNTP - 伯德法 = 0.053，P < 0.001）。NTP比率（古德法，P = 0.954；伯德法，P = 0.452）或鼻小柱 - 唇角度（P = 0.116）无显著差异。并发症包括SEG组中更多的鼻尖 - 鼻小柱偏斜（5.23%对1.
