Extension Graft Research Articles

Evaluation of the Results of Septum Extension Batten Graft in Patients Referred for Septorhinoplasty

Abstract Introduction Correction of caudal septal deviations has always been a challenging subject in septorhinoplasty. The septum batten extension graft (SBEG) is a new graft that has potential properties in rhinoplasty. However, few reports have evaluated the surgical outcomes of this technique. Objective The purpose of this study was to evaluate the effectiveness of SBEG in correcting caudal septal deviation. Methods This cross-sectional study was conducted on patients with caudal septal deviation undergoing septorhinoplasty using SBEG at 2 different hospitals in 2019. We then retrospectively reviewed medical records and photographs of 50 patients at the preoperative period, as well as at 1-month, and 12-month postoperatively. Gross changes in nasolabial angle, columellar show, nasal tip projection, and dorsal nasal deviation were evaluated by a photographic analysis method, and nasal obstruction was assessed by patient satisfaction with breathing. Results There was a significant difference between the mean nasolabial angle and columellar show at 1 and 12-months postoperatively, compared with the previous values (p < 0.0001). The nasolabial angles were in a favorable position with an increase of 12 to 15 degrees compared with the preoperative state. The columellar show also improved by an average of 1.2 mm and was in good condition. The postoperative dorsal nasal deviation was significantly reduced, and projection was significantly increased (3.521 ± 0.087 mm vs. 0.719 ± 0.028; p < 0.0001; p < 0.001). Moreover, this method had a significant favorable effect on nasal obstruction (p = 0.049). Conclusion Our results showed that septorhinoplasty using SBEG is useful for correcting caudal septal deviation, with favorable surgical outcomes, and it has responded well to all five aforementioned criteria.

Septal Extension Graft Fixed in the Middle in Rhinoplasty

Septal Extension Graft Fixed in the Middle in Rhinoplasty

Columellar graft versus Septal Extension Grafts in Open Rhinoplasty (Control of Nasal Tip Position in thick skin population)

Columellar graft versus Septal Extension Grafts in Open Rhinoplasty (Control of Nasal Tip Position in thick skin population)

Long-Term Control of Nasal Tip Position: Quantitative Assessment of Caudal Septal Extension Graft.

Control of nasal tip position is critical to final rhinoplasty outcomes. Two frequent methods of exerting tip control are columellar strut and caudal septal extension graft (SEG). Past work has demonstrated that SEG are better able to preserve tip position. However, there is no quantitative data describing long-term projection and rotation. The purpose of this study was to analyze long-term maintenance of tip projection and rotation following SEG. A retrospective study of adult patients undergoing open rhinoplasty was conducted. Three-dimensional photogrammetric evaluation of nasal tip position was performed. Anthropometric points were analyzed preoperatively and postoperatively. Outcome variables were tip projection, tip rotation, and nasal length. Twenty patients were included with an average follow-up time of 3.3 years (2.0 - 6.6 years). From postoperative week 1 to 6, there was a statistically significant decrease in rotation (-4.3%, p<0.01). There were no statistically significant decreases in projection, rotation, or nasal length from 6 weeks postoperative to 2 years postoperative, or from 6 weeks postoperative to final follow-up (2.0 - 6.6 years). Nasal tip projection and rotation appear to decrease from the immediate postoperative position, likely due to resolving edema. In this study, patients that underwent open rhinoplasty with SEG experienced modest loss of projection and rotation until 6 weeks postoperative, but projection and rotation were maintained from 6 weeks postoperative to 2 years and beyond. This study provides evidence that SEG maintains long-term changes in tip projection and rotation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Tip Support in the Cleft Lip Rhinoplasty: A Comparison of Septal Extension Graft and Columellar Strut Graft.

We aimed to comparatively analyze nasal projection and rotation changes in patients that underwent secondary cleft rhinoplasty with a columellar strut graft (CSG) or septal extension graft (SEG). Thirty-three patients were randomly divided into two groups. Preoperative, intraoperative (immediate postoperative), postoperative 1-, 6- and 12-month profile view pictures were analyzed. The nasion (N), alar base-cheek junction (A), tip defining point (T), columella (C), and lips (L) were marked. The AT/AN ratio, NAT angle, Goode ratio, and columellar-labial angle (CLA) were measured. Regarding tip projection, the AT/AN ratio was lower in CSG group compared to SEG group postoperatively. In CSG group, there was a significant progressive decrease in the AT/AN ratio, whereas in SEG group, it decreased until postoperative 6 month. Regarding tip rotation, the NAT angle was higher in CSG group postoperatively and increased progressively. In SEG group, the NAT angle was lower intraoperatively compared to the postoperative period, whereas it did not differ significantly in-between follow-ups. The Goode ratio was significantly lower in CSG group compared to SEG group postoperatively. In SEG group, the Goode ratio was significantly higher intraoperatively compared to the postoperative period, but it did not differ significantly in-between follow-ups. In CSG group, the Goode ratio decreased progressively. The CLA decreased in both groups, but there was no statistically significant difference between the groups. Secondary cleft lip rhinoplasty is a distinct subgroup of rhinoplasty that necessitates stable and strong tip support. SEG provides more reliable and predictable long-term results in secondary cleft lip rhinoplasty than CSG. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Commentary on: "Septal Advancement Flap" by Ferriera: Caudal Septal Extension Graft, Columellar Strut, or the New Septal Advancement Flap.

The septal advancement flap is introduced as a new technique to support the nasal base in preservation rhinoplasty. The SAF is a septal flap composed of the caudal septum in continuity with the high strip incision used in dorsal preservation. The technique is supported with a strut of cartilage between the medial crura. The SAF has been evaluated using mathematical models and a finite element mesh to verify the stability of the graft. The SAF is compared with the caudal septal extension graft and columellar strut and discussed in the context of all three options for stabilizing the base of the nose in rhinoplasty. The pros and cons of each as well as details about refinements of the caudal septal extension graft are discussed.

Superiority of the Septal Extension Graft over the Columellar Strut Graft in Primary Rhinoplasty: Improved Long-Term Tip Stability.

Columellar strut grafts and septal extension grafts are commonly used support structures; however, their relative effectiveness remains debated. The purpose of this study was to compare the long-term stability of septal extension grafts to that of columellar strut grafts. A retrospective review of all primary rhinoplasties performed by the senior author (R.J.R.) from 2016 to 2019 was performed. All adult patients undergoing primary open rhinoplasty with at least 1 year of follow-up were included. Revision cases and those in whom rib grafts were used were excluded. Standardized postoperative imaging was assessed at 2 months (early) and at 12 months (long-term) to measure projection/rotation change over time. Univariate and multivariable statistical comparisons were performed. The chart query yielded 133 patients. Of these, 40 patients were treated with a columellar strut and 37 patients were treated with a septal extension graft. Projection loss at 1 year was 4.7% for the columellar strut group compared with 0.2% for the septal extension graft group ( P < 0.0001). On multivariable logistic regression, there was a 5.1-fold increased risk of greater than 4% projection loss when using a columellar strut ( P < 0.005). Mean rotation loss for the columellar strut group was 4.9 degrees compared with 1.3 degrees for the septal extension graft group ( P < 0.0001). The independent effect of columellar strut use resulted in a 2.8-fold increased risk of rotation loss greater than or equal to 5 degrees ( P < 0.05). Septal extension grafts result in effectively no loss of projection and minimal loss in rotation. A small degree of projection and rotation loss can be expected with the use of a columellar strut alone. These long-term graft tendencies should be anticipated and accounted for appropriately. Therapeutic, III.

Single Stage Nasal Reconstruction for Solitary Neurofibroma Isolated in the Columella.

Neurofibromas are benign peripheral nerve sheath tumors that can originate from several elements of peripheral nerves, including axons, Schwann cells, endoneurial fibroblasts, and perineurial cells. The occurrence of a solitary neurofibroma in the external nose, especially that isolated in the nasal columella, is extremely rare. To the best of our knowledge, only 4 cases of solitary neurofibromas in the external nose have been reported in the English literature: on the nasal dorsum, tip, and pyriform aperture, all originating from the trigeminal nerve. We report the first case of a solitary neurofibroma isolated in the nasal columella, which we found in an otherwise healthy 42-year-old man. We completely resected this tumor with a negative resection margin and performed reconstruction with a bilateral spreader graft and caudal septal extension graft using autologous septal cartilage. The postoperative course was successful in both cosmetic and functional results, with no sensory changes at the 1-year follow-up. Surgical treatment for this lesion was challenging due to the cosmetically obvious location and high rate of recurrence. A review of the literature highlights the clinical and histological characteristics, differential diagnosis, and management of solitary neurofibroma of the external nose.

Effect of septal extension graft on nasal tip support: A finite element analysis

Septal extension graft (SEG) is an effective method to control the projection, rotation, and shape of the nasal tip. However, the structural mechanics of SEG have not yet been adequately determined. The purpose of this study was to examine the effect of SEG parameters on nasal tip support using finite element analysis. A multicomponent nasal model was constructed from a computed tomographic scan. A control model without graft and a total of 15 models with different SEGs were created, regarding the direction, length, width, and piece of SEG. The nasal tip compression was simulated to analyze the von Mises stress, reaction force, and strain energy of the tip structure. The SEG increased the max stress, reaction force, and strain energy of the nasal tip compared to the normal control. The SEG perpendicular to the nasal dorsum resulted in the highest maximum stress, reaction force, and strain energy for the same size of SEG. With the length increasing from 15×8×1mm to 25×8×1mm, the reaction force remained relatively stable, but the stress on the graft reduced significantly. Adding the width and pieces of the SEG increased the reaction force and strain energy of the tip. The placement of SEG can strengthen the nasal tip support. The direction, length, width, and piece of SEG have an impact on the mechanics. Diagnostic, III.

A reinforced framework construction technique using unilateral auricular cartilage in Asian rhinoplasty to prevent long-term nasal tip drooping

Enhancing nasal tip projection is an important objective in Asian rhinoplasty. Nasal tip enhancement using auricular cartilage is simple and suitable for Asian patients. However, the long-term retraction problem of the auricular framework still needs to be solved for optimal results. The authors propose a modified auricular cartilage framework construction technique that provides stronger long-term support to the nasal tip and columellar base. Eighty-one patients underwent augmentation rhinoplasty between January 2016 and December 2019. The cymba and cavum conchae were harvested from one ear in all cases. The cymba concha was carved and folded to form a caudal septal extension graft (CSEG). The cavum concha was divided into an integrated cap/shield graft and a columella base graft. The columella base graft was diced into particles in size of 1mm3, and inserted into the gap between CSEG, anterior nasal spine, and the medial crus to strengthen the foundation. The nasal profile was analyzed before the operation and at least 12 months after the operation. The patient satisfaction score was assessed 12 months after surgery. Patients were followed up for 12-36 months. The nasal tip projection from both the lateral and basal views was significantly improved. The columella-labial angle was increased from 83.15° (6.20°) to 96.50° (7.40°) (p<0.05). The nostril tip proportion increased from 0.83 (0.14) to 1.17(0.16) (p<0.01). A stable long-term outcome was achieved. With the modified framework construction technique, long-term nasal tip drooping can be prevented. This method can be a practical choice for Asian patients seeking augmentation rhinoplasty.

Vertical Alar Lengthening technique in correcting short noses

BackgroundIt is crucial that the nose length must be compatible with the face in order to obtain beautiful results that suits the face. Shorter and upturned noses appear as if the tip of the nose is cut from the front and gives a piggy appearance to the patient's face. ObjectiveThe aim of this study is to obtain longer noses with increased tip definition by effectively lengthening the medial and lateral crura's in patients with short nose and Asian noses. Materials and methodsVertical Alar Lengthening (VAL) technique was applied to 17 revision and 12 primary Asian noses. VAL technique consists of three steps. In the first step, the medial crus were lengthened by stealing from the lateral crus. Later, a lateral crural extension graft was applied to the shortened lateral crus, and the lateral crus was lengthened and sutured to the medial crus. In the final stage, a subdomal graft was placed and supported in the space formed underneath the alar tip between the mucosa and the new dome. They were followed in average 12 months (between 6 and 18 months). ResultsVAL technique was applied to 17 revision and 12 primer Asian noses. Suggested surgical technique move the tip forward and downward reduced its cephalic rotation and lengthened the nose. Targeted tip point, rotation and projection results were achieved in all patients. All patients had satisfactory esthetic results. ConclusionsIn revision cases and short nose deformities in Asian noses, the nasal tip point was extended forward and downward with the VAL technique, reducing its rotation and lengthening the nose.

The aortic uncrossing procedure

ObjectiveCross-sectional imaging allows identification of rare patients with a vascular ring and circumflex aorta. The key diagnostic feature is crossing of the transverse aortic arch from right to left posterior to the trachea and superior to the carina in a patient with a right aortic arch. We evaluated our patients who received an aortic uncrossing procedure. MethodsWe reviewed all patients who underwent aortic uncrossing from 2002 to 2022. All patients received preoperative computed tomography imaging and bronchoscopy. ResultsEleven patients ranging in age from 1.5 to 10 years (median 4 years) underwent aortic uncrossing. Two patients had prior left ligamentum division, and 3 patients had prior left aortic arch division. All had significant clinical symptoms. Eight patients had deep hypothermic circulatory arrest (mean 34 minutes), and 3 patients had antegrade cerebral perfusion (median, 28 minutes). Patch material was not used for aortic augmentation, and no patient underwent a posterior tracheopexy or rotational esophagoplasty. Postoperative length of stay ranged from 4 to 31 days (median, 5 days). One patient required a temporary tracheostomy for bilateral recurrent laryngeal nerve paresis, which recovered. One patient required an aortic extension graft to alleviate esophageal compression from an unusual ectatic esophageal course. All patients had relief of airway symptoms and dysphagia. ConclusionsIn properly selected patients with a right aortic arch and circumflex aorta, aortic uncrossing is a safe and effective therapy to treat airway and esophageal compression. The procedure can be conducted with deep hypothermic circulatory arrest or antegrade cerebral perfusion. Careful attention to the location of the esophagus and recurrent laryngeal nerves is required.

Changes in Nasal Tip Aesthetics Over Time Following Asian Tip Plasty.

This study aimed to evaluate the sequential postoperative changes in tip aesthetics, by evaluating the aesthetic performance of the septal extension graft with or without tip grafting. A total of 62 patients who underwent rhinoplasty with tip plasty were included. Using a three-dimensional scanner, we measured anthropometric aesthetic features of the nasal tip, including tip height, tip width, nasolabial angle, and columellar lobular angle. Preoperative and 1-month and 12-month postoperative anthropometric parameters were compared. The patients were grouped according to surgical techniques (i.e., septal extension only and septal extension plus tip grafting groups) and subtype of tip graft. The 1-month postoperative values of all four aesthetic features were significantly increased compared with the preoperative values. The tip height, tip width, and nasolabial angle at 12 months were significantly decreased compared with 1 month post-operation values, whereas the tip height and width were still greater than the preoperative values. No difference was found between 1 and 12 month values of columellar lobular angle. There were no differences in the degree of decrease in tip height, tip width, nasolabial angle, and columellar lobular angle between the septal extension graft only and septal extension graft plus tip graft groups. There were no differences in the tip graft by subtypes, single- and multi-layer tip grafts. Increased tip height, tip width, and widened nasolabial angle gained immediately after septal extension grafting surgery gradually decreased over the year regardless of addition of tip graft or tip grafting methods. 4 Laryngoscope, 134:678-683, 2024.

Role of Rib Graft for Tip Shaping in Primary Rhinoplasty: A Retrospective Case Series of 30 Patients.

In primary rhinoplasty, use of harvested septal cartilage often precludes the need for rib graft. Nonetheless, there are a number of indications for the use of rib graft in primary rhinoplasty. The purpose of this study was to identify the indications and techniques for rib graft use in primary rhinoplasty. A retrospective review was performed on all patients who underwent primary rhinoplasty performed by a single surgeon over a 5-year period. From these patients, those who required the use of fresh frozen allograft rib cartilage were identified. Medical record review was performed to identify demographics, ethnicity, and history of nasal trauma. Photographic analysis was also performed. Thirty of 638 consecutive primary rhinoplasties (4.7%) required rib graft. Of these, 7 patients (23.3%) demonstrated a history of nasal trauma. Furthermore, a high proportion of primary rhinoplasty patients requiring rib graft were from Asian ( n = 7 [23.3%]), Middle Eastern ( n = 4 [13.3%]), Hispanic ( n = 7 [23.3%]), and African American ( n = 9 [30%]) backgrounds. White patients were in the minority ( n = 2 [6.7%]). All primary rhinoplasties using rib graft implemented a septal extension graft. The present study demonstrates that patients requiring a rib graft in primary rhinoplasty invariably receive a septal extension graft. Furthermore, certain ethnicities associated anatomical characteristics correlated with the need for a rib graft for tip shaping. Ultimately, the use of a septal extension graft in primary rhinoplasty allows for precise and robust projection, rotation, and tip shaping in noses with thick skin, weak cartilaginous framework, and history of nasal trauma. Risk, IV.

Combined Cartilage Graft Reconstruction of the Nasal Tip Complex after Resection of Nasal Tip Schwannoma: A Case Report

ABSTRACT&#x0D; Objective: To present a rare case of nasal tip schwannoma and describe its resection and reconstruction using combined cartilage grafts.&#x0D; Methods:&#x0D; Design: Case Report Setting: Tertiary Government Training Hospital Patient: One&#x0D; Results: A 13-year-old boy presented with a progressively enlarging nasal tip and severe left nasal obstruction causing breathing difficulties and psychosocial distress. There was a bulging septal mass obstructing 90% of the left nasal cavity. Septal incision biopsy revealed schwannoma and definitive surgery via open rhinoplasty approach was done. The non-encapsulated schwannoma extended from the subcutaneous nasal tip to the left septal mucosa. There was no evidence of skin or cartilage invasion, but prolonged pressure from the expansile schwannoma caused severe lower lateral cartilage and anterior septal atrophy leading to a collapsed and expanded nasal tip after resection. To correct this, a total reconstruction of the anterior tip complex was done using combined ear cartilage seagull wing graft, shield graft and septal extension graft. Conclusion: Nasal tip and septal schwannoma is rare and can cause significant nasal obstruction and deformity. Complete excision is vital to avoid recurrence. Total reconstruction of the lower lateral cartilages using autologous septal and ear cartilage grafts may be a safe and effective technique that yields acceptable aesthetic results.

Application of a Single T-Shaped Porous High-Density Polyethylene in Oriental Nasal Tip-Plasty.

Porous high-density polyethylene (pHDPE) is an alternative material for septal extension grafts. This study investigated the clinical application of a single T-shaped pHDPE graft combined with auricular cartilage in oriental nasal tip-plasty. A retrospective analysis was conducted of 66 patients who underwent septal extension graft with a T-shaped pHDPE and auricular cartilage graft from December 2018 to November 2021. All patients were female from 19 to 51 years old (average: 28.9 years). Patients were followed up for 5 to 40 months with an average of 23.8 months. The postoperative nasal length (39.8±3.7mm) was significantly improved (35.6±5.7mm preoperatively, P <0.0001) with the tip projection increasing from 23.9±2.3mm preoperatively to 25.3±2.4mm postoperatively ( P =0.0005). There was a significant difference in the nasolabial angle (96.8±14.1 degrees preoperatively versus 101.8±7.2 degrees postoperatively, P =0.0105) but no significant change in the nasofrontal angle (143.3±9.5 degrees preoperatively versus 143.7±5.5 degrees postoperatively, P =0.7546), with an improved tip projection achieved in 93.9% of patients. One patient had an abscess in the nasal septum and a tip graft was performed using auricular cartilage in another patient because of an insufficient postoperative tip projection. There was a slight tip deviation in 2 patients, 1 case of a deviated nasal tip was corrected with a pHDPE sheet graft, while the other was left intact. Two patients had excess cartilaginous graft protruding to the nasal cavity that did not affect nasal ventilation and the shape of the nasal tip was relatively good, so the prominent cartilaginous graft was not addressed. In conclusion, this technique not only improved the bulbous nasal tip, lengthened the short nose, and increase the tip projection, but also prevented absorption of the existing septal cartilage and reduced infection or extrusion of the pHDPE.

Structural Approach to Secondary Repair of the Unilateral Cleft Lip Nasal Deformity.

Management of the unilateral cleft lip nasal deformity is complex because of the underlying significant asymmetry of the lower lateral cartilages and soft tissues of the nasal base. Suturing and grafting techniques may leave the patient with residual asymmetries of the nasal tip and nostrils. Some of this residual asymmetry may be attributable in part to the anchoring effect of the vestibular skin attachments to the lower lateral cartilages. This article discusses the use of lateral crural release, repositioning, and support with lateral crural strut grafts to manage the nasal tip. The technique involves freeing the vestibular skin from the undersurface of the lateral crura and domes and placement of lateral crural strut grafts with or without amputation of the ipsilateral dome and lateral crura to allow precise resuturing to the caudal septal extension graft. This technique is coupled with the use of a caudal septal extension graft to stabilize the nasal base and provide a strong foundation for the repair. Treatment of the nasal base may require skeletal augmentation to aid in creating symmetry of the alar insertions. Costal cartilage is needed in most cases to provide adequate structural support. Nuances in technique are discussed to help maximize outcomes.

MEASUREMENTS OS PROJECTION AND ROTATION OF THE NASAL TIP IN PRIMARY RHINOSEPTOPLASTY: A LITERATURE REVIEW

Introduction: Postoperative scarring can later modify the structure of the nose and there are few articles found in the literature that demonstrate anthropometric measurements in the evolution of the postoperative period of rhinoseptoplasty. Objective: To identify variations in projection and rotation results of the nasal tip after primary rhinoseptoplasty with the course of healing. Materials and methods: A literature review on projection and rotation of the nasal tip in primary rhinoseptoplasty, in addition to the illustration of three clinical cases of caucasian patients with medium skin who underwent open primary rhinoseptoplasty. Results: In the three illustrated cases, there was an increase in the rotation of the nasal tip in the seven-day postoperative, with an average of 13.68º in the female cases and 5.15º in the male case. There was an average reduction of 2.41º after six months of healing. There was no pattern of variation in the tip projection measurement. Discussion: The rotation of the nasal tip is measured from the nasolabial angle and the projection is equivalent to the distance that it projects from the face, which can be measured using the Goode method. Currently, one of the biggest discussions in rhinoplasty is the long-term maintenance of tip rotation and projection in closed access techniques with columellar strut and structured open access techniques using the septal extension graft. Conclusion: The rotation of the nasal tip varies considerably in the initial postoperative period, but it drops on average 2-3º six months later. The projection of the nasal tip did not present great differences. For more significant results, studies with a larger number of patients are necessary.

Feminizing Rhinoplasty: A Systematic and Institutional Review of Operative Techniques and Clinical Outcomes

Background: Facial gender-affirming surgery encompasses a myriad of procedures ranging from skeletal to soft tissue maneuvers depending on the manifestation of dysphoria in individual patients. In this work, we reviewed techniques for feminizing rhinoplasty in a single center and performed a systematic review of the literature. Methods: A systematic literature review was performed in order to survey articles that discussed techniques and clinical considerations when performing rhinoplasty among transgender females and non-binary patients. In addition, a retrospective review of such patients undergoing rhinoplasty by the senior author. Variables collected included demographic factors, operative details, and post-operative events. Results: Initial review yielded 56 articles. Standardized application of inclusion and exclusion criteria resulted in a total of 12 studies. Priorities of feminizing rhinoplasty entail reduction of dorsal hump, as well as tip refinement and deprojection. Sixty-five patients were included for analysis. The majority of patients underwent rhinoplasty through an open approach (83%). For the dorsum, 89% received dorsal reduction and 80% underwent percutaneous osteotomies. For tip work, 37 (56.9%) received a septal caudal extension graft, while a minority of patients required columellar strut (25%) or tip graft (8%). For functional restoration, septoplasty (71%) and spreader flaps/grafts (58%) were utilized to correct internal valve collapse, while alar rim (8%) and alar crural strut (3%) grafts were performed to address external valve collapse. Complications included septal deviation, hypertrophic scar, and contour irregularity. Two patients required revision (3%). Conclusion: The core tenets of the operation lie in the reduction of the nose, tip deprojection and rotation, as well as the creation of harmony with other facial structures. Our multi-pronged analysis presents an updated review of these principles, as well as a longitudinal outlook on outcomes associated with feminizing rhinoplasty.

Long-term Control of Nasal Tip Position: Quantitative Assessment of Caudal Septal Extension Graft

Abstract Goals/Purpose Control of nasal tip position is critical in final rhinoplasty outcomes. Two frequent methods of exerting tip control are columellar strut and caudal septal extension grafts. Past work has demonstrated that septal extension grafts are better able to preserve tip rotation over time. However, there is no quantitative data describing long term projection and rotation with septal extension grafts, which is essential to the final aesthetic result. The purpose of this study was to analyze long term maintenance of tip projection and rotation following septal extension graft. Methods/Technique A retrospective cohort study of adult patients undergoing open rhinoplasty was conducted. Open rhinoplasty with three-dimensional data and use of septal extension graft were collated. Excluded were closed rhinoplasty, cleft rhinoplasty, tip rhinoplasty only, cases where deprojection or derotation was implemented, and cases less with than 2 years of follow up. All patients underwent osteotomies, tip projection, and tip rotation. Three-dimensional photogrammetric evaluation of nasal tip position was performed preoperatively and postoperatively (Vectra; Canfield Scientific, Parsippany, N.J.). Anthropometric points were analyzed preoperatively, 1 week postoperative, 6 weeks postoperative, 2 years postoperative, and at final documented follow up. Outcome variables were tip projection, tip rotation, and nasal length. Nasal projection was measured from the piriform to pronasale, and nasal length was measured from radix to pronasale. Nasolabial angle was defined using three points (tip, subnasale, and Cupid’s bow). Results were compared statistically using dependent t-test. Results/Complications A total of 20 patients were included. Average follow up time was 3.3 ± 1.3 years (2.0 to 6.6 years). 15 patients underwent primary rhinoplasty and 5 underwent secondary rhinoplasty. Overall, 75 percent were female, with an average age of 25.5 years at the time of surgery. From 1 week to 6 weeks postoperative, there was a decrease in rotation (-4.3%, p&amp;lt;0.01) as well as an observed but not statistically significant decrease in projection (-1.5%) and nasal length (-0.9%). There was no statistically significant decrease in projection, rotation, or nasal length from 6 weeks postoperative to 2 years postoperatively, or from 6 weeks postoperatively to final follow up (2.0 to 6.6 years). Conclusion Nasal tip projection and rotation appear to decrease from the immediate postoperative position, likely due to resolving edema. In this study, patients that underwent open rhinoplasty with septal extension graft experienced modest loss of projection and rotation until 6 weeks postoperative, but maintained projection and rotation from 6 weeks postoperative to 2 years and beyond. This study provides evidence that septal extension graft maintains long term changes in tip projection and rotation.