Does a columellar strut change the columella, or is it only used to support the tip? if it does modify the columella, how so?

This is a good question and the roles of a columellar strut can vary. First of all we should define what this cartilage graft is. Usually it is a piece of cartilage from the septum used to strengthen or re-position the area of the nose between the nostrils. The strut can be used to increase the projection of the tip, the angle of the nose on the face, or to straighten the area between the nostrils. In certain circumstances it can be used to help breathing problems.In it's simplest form it just creates stiffness to prevent scar or gravity from pulling the tip down. This is a very common technique used in rhinoplasty with many variations.

The columellar strut is primarily used to support the tip but it has other functions as well. It helps to position and stabilize a weak tip. It helps to properly position and support the placement of tip grafts. It also can change the angle between the columella and upper lip.

Hello and thank you for your question. If it is placed properly, a columellar strut should support the tip without adversely affecting the shape or size of the columella.  Make sure you
specifically look at before and after pictures of real patients who have
had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a
surgeon you are comfortable with. I recommend that you seek consultation with a
qualified board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon