Patient-Reported Outcomes and Complications After Structural Rhinoplasty Using Septal Extension Grafts

Structural rhinoplasty is performed to achieve stable and lasting aesthetic and functional outcomes by rebuilding and maintaining the nasal framework. Among nasal tip support techniques, the septal extension graft (SEG) is widely used due to its ability to provide reliable control of nasal tip projection and rotation while maintaining structural stability.

Surgical success in rhinoplasty is not limited to anatomical outcomes alone. Patient perception of nasal function and appearance plays a key role in overall satisfaction. Therefore, patient-reported outcome measures (PROMs) have become an important component in outcome assessment.

Despite the widespread use of SEG, prospective data evaluating longitudinal changes in PROMs together with postoperative clinical findings remain limited. Clinical factors such as tip stiffness, palpable grafts, columellar deviation, and the need for revision surgery may influence patient-reported outcomes, but their relationship with PROM score changes over time has not been clearly defined.

This study is designed as a single-center, prospective observational cohort including consecutive adult patients undergoing primary structural rhinoplasty with SEG-based tip support. All procedures will be performed by the same surgical team using a standardized structural approach, with additional techniques applied as required based on individual anatomical characteristics.

Patient-reported outcomes will be assessed using validated instruments, including the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS), the Rhinoplasty Outcome Evaluation (ROE), and the Nasal Obstruction Symptom Evaluation (NOSE) scale. Assessments will be performed preoperatively and at postoperative follow-up visits.

Follow-up evaluations are planned at approximately 1, 3, and 6 months. Early postoperative assessments may be influenced by edema; therefore, later time points will be considered more representative of stable outcomes.

Data will be collected prospectively using standardized case report forms with predefined variables. PROM data will be obtained through patient-completed questionnaires at each visit. Clinical findings, including postoperative status and complications, will be recorded during routine follow-up examinations. Data entry will be performed contemporaneously at each visit.

Postoperative complications will be recorded and categorized according to timing. Revision procedures occurring during the follow-up period will also be documented. The study is structured to allow evaluation of longitudinal changes in PROM scores and to explore potential associations between patient-reported outcomes and clinical findings.

Consecutive patient inclusion will be used to reduce selection bias. Data quality will be supported by predefined variable definitions, consistency checks, and periodic data review. Missing data will be documented and handled using appropriate statistical methods for repeated measures analyses.

This study aims to characterize longitudinal changes in PROM scores and their relationship with postoperative clinical findings in patients undergoing SEG-based structural rhinoplasty.

Primary outcomes

• Change from Baseline in Total Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) Score at Postoperative Month 6 [Baseline to postoperative month 6]: Change in the total score of the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) from preoperative baseline to postoperative month 6. The SCHNOS score ranges from 0 to 100, with higher scores indicating worse nasal symptoms and poorer aesthetic outcomes. Postoperative month 6 represents a time point at which most postoperative edema has subsided and nasal structures are relatively stable.

Secondary outcomes

• Change from Baseline in Rhinoplasty Outcome Evaluation (ROE) Score at Postoperative Month 6 [Baseline to postoperative month 6]: Change in the score of the Rhinoplasty Outcome Evaluation (ROE) from preoperative baseline to postoperative month 6. The ROE score ranges from 0 to 100, with higher scores indicating better patient satisfaction and improved outcomes
• Change from Baseline in Nasal Obstruction Symptom Evaluation (NOSE) Score at Postoperative Month 6 [Baseline to postoperative month 6]: Change in the score of the Nasal Obstruction Symptom Evaluation (NOSE) scale from preoperative baseline to postoperative month 6. The NOSE score ranges from 0 to 100, with higher scores indicating more severe nasal obstruction symptoms.
• Revision Surgery Rate Within 6 Months [Up to postoperative month 6]: Proportion of patients requiring revision surgery within 6 months following the primary rhinoplasty procedure.

Other outcomes

• Change from Baseline in Total Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) Score at Postoperative Month 1 [Baseline to postoperative month 1]: Change in the total score of the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) from preoperative baseline to postoperative month 1. The SCHNOS total score ranges from 0 to 100, with higher scores indicating worse nasal symptoms and poorer aesthetic outcomes.
• Change from Baseline in Total Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) Score at Postoperative Month 3 [Baseline to postoperative month 3]: Change in the total score of the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) from preoperative baseline to postoperative month 3. The SCHNOS total score ranges from 0 to 100, with higher scores indicating worse nasal symptoms and poorer aesthetic outcomes.
• Change from Baseline in Rhinoplasty Outcome Evaluation (ROE) Score at Postoperative Month 1 [Baseline to postoperative month 1]: Change in the score of the Rhinoplasty Outcome Evaluation (ROE) from preoperative baseline to postoperative month 1. The ROE score ranges from 0 to 100, with higher scores indicating better patient satisfaction and improved outcomes.
• Change from Baseline in Rhinoplasty Outcome Evaluation (ROE) Score at Postoperative Month 3 [Baseline to postoperative month 3]: Change in the score of the Rhinoplasty Outcome Evaluation (ROE) from preoperative baseline to postoperative month 3. The ROE score ranges from 0 to 100, with higher scores indicating better patient satisfaction and improved outcomes.

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Age 18 years or older
* Undergoing primary structural rhinoplasty with septal extension graft
* Able to understand and complete patient-reported outcome questionnaires (PROMs)
* Willing to participate and provide written informed consent

Exclusion Criteria:

* History of previous nasal surgery (revision rhinoplasty)
* Undergoing concomitant major craniofacial procedures
* Missing preoperative PROM data
* Unable to complete postoperative follow-up assessments

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• Murat Çelik, Assistant Professor, Principal investigator, Cumhuriyet University