Is it absolutely necessary to have a columellar graft with an open rhinoplasty?

is it necessary and if so, why? Thank you in advance

Doctor Answers 6

How frequent are columellar strut grafts with an open approach to rhinoplasty?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
By it's very nature, an incision across the columella (the open approach to rhinoplasty) causes some loss of support to it and the nasal tip. The degree depends on the characteristics of the cartilage, skin and surrounding soft tissue. Dr Goodman, (well known within the rhinoplasty community as the surgeon who introduced the open technique to North America) practiced in Toronto and as a result Toronto remains a center of excellence for open rhinoplasty. Here in Toronto it's uncommon not to use a columellar strut with open rhinoplasty. There are several advantages and really no disadvantages in the hands of an experienced open rhinoplasty surgeon. So it isn't absolutely necessary to use a strut graft with open rhinoplasty, however the real question is why would you not use it?

Columellar strut and open rhinoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The majority of primary rhinoplasties can be performed through closed rhinoplasty techniques, not open rhinoplasty. We only perform columellar struts in rare cases when there is poor tip support to the nasal tip. For many examples of closed rhinoplasty without columellar struts, please see our photo gallery link below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Columella struts

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

When I first went into practice I almost always used columella struts. Now, I almost never use them. I think it depend upon what type of tip support you need and how much you deconstruct the tip during the procedure.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Is it absolutely necessary to have a columellar graft with an open rhinoplasty?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

A columellar strut graft is only necessary if there is poor tip support from the underlying cartilage anatomy. In any artistically performed procedure, you do what is necessary to achieve the best cosmetic and functional result. If it is not necessary to achieve the required end result, you don't need to do it. I have performed numerous rhinoplasties with excellent cosmetic results, some using a columellar strut graft and many without the graft.

Keep in mind that following the advice from a surgeon on this or any other website who proposes to tell you what to do without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure would not be in your best interest. I would suggest
you find a plastic surgeon certified by the American Board of Plastic Surgery
and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) or facial plastic surgeon (otolaryngologist) with extensive rhinoplasty experience that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 22 reviews

Is it absolutely necessary to have a columellar graft with an open rhinoplasty?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

There are surgeons who state that a strut is required after every open rhinoplasty. However, this is not always the case and becomes apparently after performing many, many rhinoplasty procedures. In cases where there is a lack of tip support, a strut is definitely indicated after open rhinoplasty. However, in cases where there is plenty of support or other maneuvers are performed the support the tip, a strut is not required. Unfortunately, one would need to examine your nose and discuss your goals in order to give you specific advice about your nose.

Open Approach Rhinoplasty and Columellar Struts

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The short answer to your question is that it is not necessary. In fact, I only use it if the medial crura need additional support or if I am using it in conjunction with a shield or domal graft to project and/or rotate the tip. By itself, a columllar strut does little to support the tip over time but there are other indications where it may be necessary.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.