a Comparative Study of Septal Extension Graft versus Derotation Graft for Short Nose Correction in Asian Rhinoplasty

초록

Background: Precise nasal tip refinement is a cornerstone of Asian rhinoplasty that addresses characteristics such as bulbous tips, short columellas, and flared nostrils. Septal extension grafts (SEG) and derotation grafts (DRG) are commonly employed to enhance tip projection; however, comparative analyses are lacking. We assessed the outcomes of SEGs and DRGs in Asian patients who underwent tip-plasty. Methods: In this retrospective study, we analyzed 729 patients who underwent nasal tip-plasty using SEG or DRG between January 2011 and December 2017. Postoperative complications were assessed after a minimum follow-up of 6 months. For patients with long-term follow-up (≥24 months), nasal tip projection (NTP) and columellar-labial angle (CLA) were measured preoperatively and postoperatively using Goode's and Byrd's methods. Results: Among 287 SEG and 142 DRG cases, both techniques showed significant postoperative improvements: SEG (Δ NTP-Goode=0.036, p=0.001; ΔNTP-Byrd=0.036, p<0.001) and DRG (ΔNTP-Goode=0.047, p=0.005; ΔNTP-Byrd=0.053, p<0.001). No significant differences were noted for NTP ratios (Goode: p=0.954; Byrd: p=0.452) or CLA (p=0.116). Complications included more tip-columella deviations in SEG (5.23% vs. 1.41%) and higher tip drooping (4.53% vs. 8.45%; adjusted p=0.040) and supratip deformity (0% vs. 2.82%; adjusted p=0.010) in DRG. Conclusions: Longitudinal analysis shows that both SEG and DRG effectively preserve tip projection over time. SEG is more prone to tip and columellar deviations, while DRG is associated with tip drooping and supratip deformity, with no difference in tip shortening relapse. Technique selection should be customized to the patient's anatomical features and the surgeon's experience to minimize complications. Copyright © 2025 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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