Background <p>The columellar strut (CSG) was developed at the start of rhinoplasty to rebuild the nasal tip′s projection and ligaments. In an effort to offer more tip assistance, the septal extension graft (SEG) surfaced as a substitute. Today, both techniques can be used and are performed by almost all rhinoplasty surgeons.</p> Methods <p>A retrospective case study of 38 patients that evaluated the indication and results of CSG and SEG after one year of follow-up to observe maintenance of projection and rotation of the nasal tip based on photographic comparison and patient satisfaction.</p> Results <p>Both CSG and SEG produce satisfactory results. Although the SEG was well advised in certain ethnic patient instances with a poorly projected nasal spine or a requirement for more septal support (<i>n&#xa0;</i>=&#xa0;9), the columellar strut is chosen in the majority of the senior author's cases due to the natural results (<i>n&#xa0;</i>=&#xa0;29) as a specialist opinion.</p> Conclusions <p>The columellar strut is still quite useful in rhinoplasty. Its key benefit, according to the senior’s author experience, is that it allows for more predictable nasal aging and provides a natural nose while preserving tip mobility.</p> Level of Evidence IV <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 &#xa0;<a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>