Nasolabial angle stability in rhinoplasty: the role of anterior extended suture with columellar strut

Rhinoplasty requires effective nasal tip stabilization to preserve projection and rotation. The Anterior Extended Suture (AES) has been proposed as a practical modification to enhance tip stability when combined with a columellar strut. This retrospective study evaluated patients who underwent primary rhinoplasty between 2019 and 2023. Eligible patients were those receiving a columellar strut with or without the Anterior Extended Suture (AES). Standardized lateral profile photographs were obtained preoperatively, intraoperatively, and postoperatively (minimum follow-up of 6 months). The nasolabial angle (NLA) was digitally measured in a blinded manner. Intraoperative-to-postoperative changes in NLA were analyzed to assess tip rotation stability. A total of 57 patients met the inclusion criteria and were analyzed. In the AES group, the mean NLA increased significantly from 95.0° preoperatively to 115.2° intraoperatively (p < 0.0001), followed by a slight decrease to 112.6° postoperatively (p < 0.0001). Despite this reduction, postoperative values remained significantly higher than baseline (p < 0.0001). In the control group, NLA increased from 94.0° preoperatively to 108.8° intraoperatively (p < 0.0001) and then decreased to 104.9° postoperatively (p = 0.0001), while still remaining significantly higher than preoperative values (p < 0.0001). When intraoperative-postoperative changes were compared between groups, the reduction was smaller in the AES group (2.58°) than in the control group (3.90°), although the difference did not reach statistical significance (p = 0.063). The AES technique, when combined with a columellar strut, showed a tendency toward better maintenance of the NLA compared with strut alone. Although the differences were not statistically significant, AES may provide additional support for tip stabilization. Further prospective and multicenter studies with larger cohorts are needed to clarify its long-term effectiveness.