Efficacy of Combined Septal Extension and Derotation Grafts in Asian Rhinoplasty: A Quantitative Analysis of Tip Projection and Stability

BACKGROUND: Short nose correction in Asian rhinoplasty is challenging due to weak septal cartilage, thick skin envelopes, and strong postoperative contractile forces that compromise long-term tip stability. OBJECTIVES: This study aimed to quantitatively compare the long-term outcomes of three nasal tip-plasty techniques-derotation graft with columellar strut (DG+CS), septal extension graft alone (SEG only), and combined septal extension with derotation graft (SEG+DG). METHODS: A total of 324 patients who underwent cosmetic rhinoplasty by a single surgeon from 2015 to 2022 were retrospectively analyzed. Standardized lateral-view photographs were used to measure nasal length, tip projection, and nasolabial angle, normalized to facial length, and expressed as percentage change over time. Long-term outcomes (>12 months) were compared using non-parametric statistical tests. RESULTS: The SEG+DG group demonstrated the most consistent and durable improvements in nasal length and tip projection across all postoperative intervals. Significant intergroup differences were observed in long-term nasal length and tip projection (p < 0.001), with SEG+DG and SEG only both outperforming DG+CS. SEG+DG also showed the lowest variability and most stable trend, whereas the nasolabial angle showed a significant omnibus difference (p = 0.009) that did not persist after post-hoc pairwise correction. Revision rates were lowest in the SEG+DG group (6.5%), compared to SEG only (10.6%) and DG+CS (14.3%). CONCLUSIONS: The combined use of septal extension and derotation grafts provides superior and sustained structural support, offering a more reliable approach for correcting short nose deformity in Asian rhinoplasty.