Background <p>Septal extension grafts (SEGs) play a critical role in rhinoplasty by enhancing nasal tip projection, stability, and rotation. Despite their widespread use, no comprehensive systematic review has evaluated their overall effectiveness and associated complications. This study aims to assess the effect of SEGs on nasal tip stability, rotation, and projection in patients undergoing rhinoplasty.</p> Methods <p>A systematic review of search databases including PubMed, MEDLINE, OpenAIRE, Scopus, and Springer Nature Journals was searched for studies reporting preoperative and postoperative nasal tip measurements. Inclusion criteria included studies with quantitative data on tip rotation and projection, tip stability, and complications.</p> Results <p>Eight studies (<i>n</i> = 584 patients) were included. Meta-analysis showed a significant increase in postoperative nasal tip rotation (SMCR = 0.76, 95% CI 0.37 to 1.15, <i>p</i> = 0.0002) and projection (SMCR = 0.99, 95% CI 0.5 to 1.47, <i>p</i> &lt; 0.001%). The overall complication rate was low 5% (95% CI 1% to 23%). Sensitivity analysis confirmed the robustness of the findings.</p> Conclusion <p>SEGs significantly enhance nasal tip rotation, projection, and stability with a low complication rate. These findings support the use of SEGs as an effective rhinoplasty technique. However, further prospective studies with standardized outcome measures are required to optimize surgical approaches.</p> Level of Evidence III <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>