Photogrammetric Comparison of Septal Extension Grafts and Columellar Strut Grafts Reinforced with Septocolumellar Sutures

Objective: To compare the effects of septal extension (SE) grafts and columellar strut (CS) grafts reinforced with septocolumellar sutures on nasal tip projection, rotation, and patient-reported outcomes in primary rhinoplasty using standardized photogrammetric analysis. Methods: This retrospective cohort study included 60 patients who underwent primary rhinoplasty between 2019 and 2024 (30 SE and 30 CS grafts reinforced with septocolumellar sutures). Nasal tip projection, rotation, and anthropometric parameters were assessed using Rhinobase software. Functional and esthetic outcomes were evaluated using the Nasal Obstruction Symptom Evaluation Questionnaire (NOSE) and Facial Aesthetic Quality of Life Questionnaire (FACE-Q). Results: The mean age was 27.8 years, and 70% of the participants were female. The mean postoperative follow-up was 9.5±2.7 months. Although baseline nasal length and tip projection were lower in the SE group, both techniques produced comparable postoperative improvements in nasal tip projection, rotation, and nasal length. Postoperative FACE-Q and NOSE scores were also similar between groups, despite lower preoperative FACE-Q scores in the SE group (p=0.003). Conclusion: CS grafts reinforced with septocolumellar sutures achieved functional and esthetic outcomes comparable to SE grafts. These findings suggest that septocolumellar suturing may compensate for the structural advantages traditionally attributed to SE grafts in primary rhinoplasty.