Does the effect of septorhinoplasty with dorsal extension graft last? What research reveals about durability and limitations

Septorhinoplasty with dorsal extension graft is a surgery that changes the height and direction of the nasal tip using a cartilage foundation, and its effects have been confirmed in multiple studies[1][2]. However, long-term data showing how many years the effect lasts is still limited, and most studies have follow-up periods of around one year or less[1][3]. The key to understanding this surgery's research is to distinguish between the 'magnitude' and 'durability' of the effect.

What degree of change was shown in research?

Improvements in nasal tip height, direction, and nose length before and after surgery have been confirmed through photogrammetry. In a study comparing 60 patients who underwent initial rhinoplasty between 2019 and 2024—30 receiving septorhinoplasty with dorsal extension graft and 30 receiving columellar strut placement—both groups showed similar improvements in nasal tip height, direction, and nose length, with no differences in aesthetic satisfaction (FACE-Q) scores or nasal airflow (NOSE) scores[1].

A systematic review of nasal tip surgery in Asian populations also concluded that combined techniques using spreader grafts, dorsal extension grafts, and columellar struts showed promising results after surgery[2]. However, only 4 studies were ultimately included in the analysis, limiting the quality of comparison[2].

How long does the effect last?

To be honest, it is not yet well understood. The follow-up period in the aforementioned 60-patient study averaged 9.5 months[1]. The authors of a study combining extended spreader grafts and dorsal extension grafts noted that while 11.28 months of average follow-up has value as short-term data, it may be insufficient to assess whether the transplanted cartilage remains stable long-term, and stated that at least 2 years of follow-up is necessary[3].

A report attempting long-term multifaceted evaluation was published in 2025[4]. When told 'it lasts for X years,' asking what study period that claim is based on will help make the discussion more concrete.

Does the cartilage material change the results?

Current research has not reached a conclusion that satisfaction varies significantly with material choice. A systematic review of 44 studies on nasal tip grafts over the past decade found satisfactory results regardless of whether autologous tissue, allograft tissue, or synthetic material was used[5]. However, this does not rank materials by superiority[5].

The practical constraint in material selection is the amount of septal cartilage available. Anatomical studies have reported that the size of septal cartilage available for grafting is considerably smaller in Asians than in Caucasians[6]. When cartilage is insufficient, the septum must be reconstructed using ear or rib cartilage, though one review stated that using autologous tissue for the nasal dorsum is safer[7].

Is it true that the nasal tip becomes stiff and bends?

Textbooks explicitly state it can occur. Drawbacks of septorhinoplasty with dorsal extension graft include stiffness of the nasal tip, a pointed appearance when smiling, and columellar deviation and nostril asymmetry when the graft is placed on one side only[8]. If the L-shaped cartilage foundation is weak, postoperative deviation can lead to asymmetry of the nasal tip, columella, and nostrils[8].

When transplanted cartilage warps, it can lead to columellar deformity and nasal obstruction[9]. When the graft is extended far to the anterior nasal spine (the bone at the base of the upper lip), horizontal wrinkles and stiffness of the upper lip may appear over several months after surgery[9]. If septal deviation develops after dorsal extension graft surgery resulting in nasal obstruction, surgical correction may be necessary[10].

Who is it suitable for, and who is it not?

The surgery is suited for people with weak support and insufficient height of the nasal tip. A review comparing columellar struts and dorsal extension grafts recommends the latter mainly for those with insufficient nasal tip height or weak support, and states that using it on those with naturally strong lower lateral cartilage (the cartilage that shapes the nasal tip) or sufficient height may result in excessive stiffness, excessive height, or unnatural direction[11].

Skin thickness also affects outcomes. Thick, tight skin at the nasal tip resists being stretched by suturing or cartilage grafting, and if the internal cartilage is weak, the nasal tip may not elevate fully or may lose height[8]. The more these characteristics—short columella, weak nasal tip support, and thick skin—overlap, the more surgical design determines the outcome.[6].

What complication is most important to avoid?

Secondary contraction deformity (a state where the nose becomes shorter and upturned due to skin contraction from infection, etc.). A review outlining septorhinoplasty with dorsal extension graft in Asian patients identifies this as the most common surgery-related complication and the most difficult to correct aesthetically[7]. Correction requires extending the nose more substantially than the initial surgery, and because the contracted skin must be overcome, strong support is needed—requiring septal reconstruction and further extension[7].

What to confirm at consultation

Important to verify is whether your nasal tip support and skin thickness are suitable for this surgery, the type and amount of cartilage to be used, and what time period the claim that 'results last' is based on. It also helps to ask in advance how stiffness or asymmetry will be managed if they occur.

How much septal cartilage is available cannot be determined without examining the inside of the nose during consultation. If there is a possibility of using ear or rib cartilage, discussion with the surgeon should include the burden of harvesting these tissues.