New Insights into the Role of Columellar Strut and Septal Extension Graft: A Comparative Review of Long-Term Outcomes.

: The columellar strut and septal extension graft are two common techniques in modern rhinoplasty to enhance nasal tip projection and rotation, though their effectiveness varies. While numerous studies examine each technique individually, there is limited research directly comparing the two methods, especially regarding long-term outcomes. This study aims to clarify the roles of these grafting techniques and possibly compare their long-term effectiveness in reconstructing caudal nasal support structures with available evidence in the literature. : A comparative study was conducted on 87 patients with structural and anatomical nasal defects who underwent rhinoplasty using either a columellar strut or a septal extension graft. Outcome variables included tip projection, tip rotation, and nasal length. Patients were evaluated pre-operatively and at intervals of 1 month, 6 months, 1 year, and 4 years post-operatively. A critical discussion was also conducted to define the roles of the two nasal grafts and assess their long-term effectiveness. : Although over 4000 publications address the use of grafts in rhinoplasty, only a few compare the two grafting techniques directly. Our analysis revealed mixed perspectives on the columellar strut: some argue it is unnecessary, while others suggest it is not superior to septo-columellar suturing techniques. Conversely, several studies highlight the septal extension graft's importance in reconstructing nasal support, with some evidence indicating it outperforms the columellar strut in maintaining long-term structure. : Both grafts contribute to increased nasal projection; however, the septal extension graft provides more stable, long-term tip position support. The columellar strut appears non-essential for enhancing tip projection and should be used selectively, as it increases projection only when specifically designed for that purpose by the surgeon.