Structural Aesthetic Septorhinoplasty Using the RAGO Strut: A Combined Septal Cartilage and Ethmoid–Vomer Plate Complex Technique to Address Nasal Tip Projection Challenges in Northeast Indian Ethnicities

Abstract Background Nasal anatomy in the Northeast Indian population often exhibits Far East Asian features such as a broad, flat dorsum, short columella, thick skin, and weak septal cartilage. These features can make conventional septorhinoplasty techniques challenging, especially in achieving and maintaining nasal tip projection (NTP). Moreover, aesthetic demands influenced by Western and pan-Indian ideals further challenge traditional approaches. Objectives The aim of this study was to evaluate the effectiveness of the Reinforced Anterior Graft Osseous (RAGO) strut, a septal extension graft complex technique, in providing long-term morphological and mechanical support for NTP in septorhinoplasty. Methods A prospective analysis was conducted on 31 patients who underwent primary (n = 27) or secondary (n = 4) septorhinoplasty using RAGO strut between February 2020 and April 2024 at RGIMS, Guwahati, India. Patients included had adequate dorsal height but presented with underprojected nasal tip. RAGO strut was harvested and secured to achieve desired NTP. Patients were evaluated using standardized anthropometric measurements (nasolabial angle, tip projection, columella-lobular angle), digital photographic analysis, and subjective satisfaction scores over 12 months. Results Postoperative nasal measurements showed mean nasolabial angles of 98.4°, 95°, and 94.4° at 3, 6, and 12 months, respectively. Similarly, mean columella-lobular angles were 41.8°, 40.2°, and 39° at the same intervals, reflecting consistent results. Tip projection was customized to each patient's aesthetic goals and remained consistent throughout follow-up. No major complications were observed, and patient satisfaction was notably high. Conclusions The RAGO strut provides stable, structural support to enhance and maintain NTP, particularly in patients with weak nasal cartilages. Level of Evidence: 4 (Therapeutic)