what is the difference between a columella strut and a shield graft? I'm due to get a columella strut soon to increase tip projection and elevate the tip but I didn't know if that's all that's required for ethnic rhinoplasty. Also, does the nose tip need to be refined if a strut is performed?
Ethnic Rhino, Is A Strut Required If Increasing The Nose Tip Projection?
Doctor Answers (4)
Rhinoplasty struts and grafts
The nasal tip is composed of 2 C-shaped pieces of cartilage that are aligned back to back. The inside curve of the C contributes to the inner and upper part of each nostril. The columella is the strip of skin between the nostrils that covers the area where the 2 C-shaped cartilages touch back to back. A columellar strut is usually a piece of cartilage and is placed between the 2 C-shaped cartilages under the columella skin. It gives support to the tip and can make the tip project further out from the face. The shield graft is a shield shaped piece of cartilage that is placed on the upper domes of these C-shaped cartilages. One shield covers both domes. They are used to create tip definition or a romanesque nose usually in noses that have round tips. When the tip skin is thick the graft has to be mutliple stacked grafts in order to see the tip definition through the thick skin. Stacking of the shields can also result in more tip projection but is not a good way to get it if increased projection is your primarily goal. The tip does not have to be refined if you place a columellar strut and will be not be more refined if all that you do is to place the strut. Whether or not you should place shield grafts is dependent on what the patient starts with before surgery, what the patient wants and what goals you want to achieve with the surgery.
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Ethic Rhinoplasty issues
A columellar strut will give the tip more support and projection. A shield graft is to give the tip more definition. They both can be used simultaneously in ethinic rhinoplasty. Ethnic noses (meaning noses of hispanic, african and asian decent) tend to have thick skin at the tip and can require more aggressive techniques to obtain tip definition.
Rhinoplasty and Columella strut vs shield graft
In rhinoplasty surgery a strut or support can be placed in the columella (the area of nasal tissue between the nostrils). The strut is designed to lengthen the columella and give the nasal tip greater forward projection. The strut can be fashioned from the patients cartilage or bone or one can use a silastic implant.
A shield graft is usually composed of the patient's ear or nasal septal cartilage and is placed in the nasal tip to augment or refine the nasal tip. Depending on the the patient's nose and what the patient and surgeon are attempting to achieve, one may use a columellar strut with or without a nasal tip shield graft.
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Ethnic rhinoplasty and need for strut
A columellar strut is sometimes required to improve tip projection of the nose. One of the side effects of tip projection will be increased rotation of the nose. A shield graft is a small graft cartilage placed on the anterior portion of the tip to give more anterior and inferior projection of the actual tip itself. The nasal tip cartilages will also need to be adjusted if a cartilaginous strut is being performed.
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