Does Laterality of the Caudal Septal Extension Graft Matter? A Photograph-Based Analysis of Symmetry in Rhinoplasty

Ideal tip projection and rotation in rhinoplasty often requires placement of caudal septal extension grafts (CSEGs). While CSEGs are ubiquitous in rhinoplasty, there remains a lack of consensus on how laterality of placement may impact symmetry over time. This study aimed to objectively assess symmetry of the tip complex over time with respect to various placements of CSEGs in relation to the septum. A retrospective chart review was conducted from 2014 to 2021 among patients undergoing septorhinoplasty who received a CSEG. Variables, including demographic information and operative details (i.e. laterality) are collected. Frontal, basal, top-down, and lateral view photographs were extracted from the pre-operative and one year post-operative clinic visits. Two independent evaluators rated nasal tip symmetry on a scale from -100 to +100, where 0 indicates perfect symmetry, negative values indicate a rightward deviation, and positive values indicate a leftward deviation. Two distinct statistical models, analysis of variance (ANOVA) and linear mixed effects, were conducted. A total of 122 patients were included. The average duration of follow-up was eighteen months. According to both implemented models, we determined that the laterality of septal extension graft placement did not have a statistically significant impact on postoperative nasal tip symmetry across different perspectives. Ensuring tip symmetry in rhinoplasty relies on a midline and straight septum. Our results found that CSEG position relative to the septum does not significantly alter overall perception of symmetry. Future studies should implement artificial intelligence to provide objective evaluations of symmetry in rhinoplasty.