A Novel Modification of Tongue in Groove Technique (Auto-Septal Projection Graft) in Rhinoplasty



Derotation of the nasal tip with narrow nasolabial angle is a common nasal deformity that leads to a long nose appearance, named drooping nose. In these patients, there are various techniques described to fix droopy tip and to achieve a desirable nasal tip rotation such as caudal septal extension graft, extended columellar strut graft, tongue in groove, columellar strut graft, and tip rotation sutures. This study aimed to evaluate changes in nasal tip support after modified tongue-in-groove technique (auto-septal projection graft).

Materials and Methods

Forty-two patients who underwent a primary open approach septorhinoplasty using the modified tongue-in-groove technique between June 2017 and March 2019 were retrospectively analyzed. Postoperative and preoperative photographs were analyzed, and nasolabial angle and the nasal tip projection ratio were recorded and compared before and average of 17.3 months after the surgery.


Forty-two patients (33 female and 9 male) were included the study. The mean nasolabial angle was 85.7° preoperatively and 99.3° postoperatively. The nasal tip projection ratio was 0.60 preoperatively and 0.64 postoperatively. Both the tip rotation and the tip projection increased significantly after the modified tongue in groove (p<0.05).


It seems that modified tongue-in-groove method (auto-septal projection graft) is an effective technique in maintaining tip projection and rotation in rhinoplasty and safe method to correct droopy nasal tip in selected cases.

Level of Evidence IV

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Correspondence to Ozan Gökler.

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Koçak, İ., Gökler, O. A Novel Modification of Tongue in Groove Technique (Auto-Septal Projection Graft) in Rhinoplasty. Aesth Plast Surg (2021). https://doi.org/10.1007/s00266-021-02184-9

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  • Rhinoplasty
  • Tip rotation
  • Tongue in groove
  • Septal extension graft
  • Tip projection
  • Nasolabial angle