Background and Aim <p>The nasal tip plays a central role in facial aesthetics, and achieving long-term tip stability is a key objective in rhinoplasty. This study compared postoperative tip stability between structural rhinoplasty using a strut graft (SG) and preservation rhinoplasty with an underlay Pitanguy ligament graft (PLG).</p> Method <p>Eighty-six primary rhinoplasty candidates were enrolled and divided into two groups of 43. One group received structural rhinoplasty with strut graft, while the other underwent preservation rhinoplasty with an underlay PLG. Nasal tip rotation and projection were measured using 3D soft tissue scans before surgery and at 3, 6, and 9&#xa0;months postoperatively.</p> Results <p>Time significantly affected tip projection (<i>P</i> = 0.001) with both groups showing a downward trend, but no significant differences were observed between techniques at 3, 6, or 9&#xa0;months (<i>P</i> &gt; 0.05). Tip rotation showed a similar pattern; no significant differences between techniques at any time point. Repeated measures ANOVA confirmed a significant effect of time on rotation (<i>P</i> = 0.001) without a significant time-by-group interaction (<i>P</i> = 0.285).</p> Conclusion <p>Both structural rhinoplasty with SG and preservation rhinoplasty with underlay PLG yield similar outcomes in maintaining tip projection and rotation over 9&#xa0;months. Time-dependent reductions were observed, but no statistically significant differences existed between techniques.</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>