Reply: Nasal Tip Flexibility and Stability: Comparison of Septal Extension Grafts and Columellar Strut Grafts in a Prospective Trial

We appreciate the thoughtful feedback from Drs. Wu and You on our article, “Nasal Tip Flexibility and Stability: Comparison of Septal Extension Grafts and Columellar Strut Grafts in a Prospective Trial.”1 It is encouraging to see our work spark discussion around the important topic of nasal tip support in rhinoplasty. In modern rhinoplasty, when referring to the columellar strut graft (CSG), the assumption is typically that it is a floating graft, and this was the concept we applied in our study. We aimed to explore 2 different approaches to nasal tip support: (1) relying on stable structures, such as cartilage or bone (represented by the septal extension graft); and (2) relying on the strength of the lower lateral cartilages and ligaments (as with the floating CSG). Our intention was to compare these 2 concepts rather than focus on the fixed CSG, which is a more rigid technique. As Wu and You noted, the fixed CSG does indeed provide more robust tip support outcomes but often at the expense of flexibility, which was not the focus of our current investigation. We agree that stable fixation can offer long-term benefits, particularly in patients who require stronger structural support. However, our study was aimed at addressing a more nuanced aspect of nasal tip stability—specifically, how much support is derived from more flexible, natural structures, such as the lower lateral cartilages and ligaments, compared with fixed, rigid support. This comparison allowed us to better understand the trade-offs in projection, rotation, and flexibility, which are all critical considerations in customized rhinoplasty planning. From our perspective, the fixed CSG can be considered a “maxillary extension graft,” similar to the popular Teostrut,2 which is actually a type of septal extension graft. Rather than focusing on terminology, our goal was to explore 2 distinct tip support mechanisms in rhinoplasty through our prospective study. We also acknowledge the importance of including a more diverse patient population in future studies. While most of our cohort consisted of White patients undergoing reduction rhinoplasty, we agree that ethnic variation and differing anatomical characteristics can influence outcomes, particularly in augmentation procedures, and should be accounted for in future research. Once again, we thank Dr. Wu and Dr. You for their valuable input. We hope this exchange continues to foster meaningful advancements in rhinoplasty techniques for diverse patient populations. DISCLOSURE The authors have no financial interest in any of the products, devices, or drugs mentioned in this communication.