Background: Rhinoplasty is considered one of the most difficult facial plastic surgeries in which the surgeon is expected to achieve simultaneous nasal coordination and alignment with other parts of the face and enhance the strength and support of the nose. The aim of this work was to compare the tip projection and rotation upon using columellar strut graft (CS) and septal extension graft (SEG) to predict the amount of tip changes aiming to reach a more predictable pre-operative planning. Methods: This prospective comparative clinical study was carried out on 40 patients seeking for aesthetic primary rhinoplasty and were considered for open rhinoplasty. Patients were divided into two groups with flipping a coin as a method of randomization: group A: CS and group B: SEG. Results: Both groups exhibit similar changes in tip projection and rotation with no significant differences when followed up for 6 months postoperative. There was no significant difference regarding surgeon or patients' satisfactions between the two studied groups. Conclusions: Nasal tip projection and rotation appear to decrease from the immediate postoperative position. Both groups exhibit similar changes in tip projection and rotation with no significant differences between both groups when followed up for 6 months postoperative.