摘要

Objectives: To analyze, through a structural-mechanics perspective, the factors contributing to tip regression in East Asian rhinoplasty, and to evaluate the potential benefits of a technique aimed at minimizing complications—specifically tip onlay graft visibility and frozen nasal tip—when achieving greater tip projection with septal extension grafts. Introduction: East Asian noses typically have a thick, firm, and relatively inelastic nasal envelope, along with a small and structurally weak osseocartilaginous framework. Because of these characteristics, patients with low dorsal height and limited tip projection continue to favor septal extension grafting in rhinoplasty. In recent years, however, there has been a growing demand in East Asia not only for a natural appearance that does not reveal signs of surgery, but also for natural tactile qualities, including the texture and mobility of the grafted cartilage. Materials / method: To prevent visibility of the tip graft and to maintain appropriate strength and mobility of the nasal tip, the author performed the double columellar strut technique, originally described by Jallut in 2014, on 82 patients over a five‑year period beginning in 2020. This method was applied to patients who did not require excessive tip projection and who possessed relatively adequate alar cartilage support. Among these cases, 12 patients with more than one year of postoperative follow‑up were evaluated. The degree of postoperative tip setback was measured using the Vectra 3D simulation software. Results: All patients showed approximately 0.5 mm of tip setback over time; however, no case demonstrated more than 1 mm of regression. Among the 82 patients who underwent this technique, two required revision surgery, both from the early phase of the series: one due to graft displacement and one due to tip setback. With the expansion of surgical options, approximately 15% of patients were able to achieve their desired long‑term tip height without undergoing septal extension grafting. Conclusion: The higher the nasal tip is elevated, the stronger the counteracting forces that push it back toward its original position. Reinforcing the tip with a more rigid support can resist these forces but may also increase the risk of graft visibility and reduced mobility. In this study, a modified double columellar strut technique was adapted to better suit East Asian anatomy and reduce these risks. Although it does not replace septal extension grafting, this approach offers a useful option for selected patients and may help meet the growing demand for natural, long‑lasting tip projection.