Why is a columella strut used?

Question

I am a bit confused. If some people are born with a nose with tips that are aesthetically pleasing and at a good angle and do not require columella struts to prevent the tip drooping, why during so many rhinoplasties is a columella strut put in after the tip is at a good angle?

Alejandro Nogueira, MD · Answer

This has a name: very deep lack of self-confidence of surgeons lacking experience, which leads them to an abuse of interventionism, unnecessarily complex (and expensive) procedures and donor site waste and morbidity.

In other words: the surgeon has no remote idea if the tip needs a strut or not, so... considering the strut provides no major harm itself (if properly executed).... let's use it! rather than regretting not using it. The worst of this policy is the "side effects", since struts are very aggressive tools at the columella, providing extraordinary degrees of tip projection and support, tightly connected with a risk of fake looking noses, over projected tips, etc. Performing surgical gestures on noses without criterion sooner or later leads to poor results or deformities.

As rhinoplasty revision surgeon I can tell you 80% of cases I receive are due to wrong indications, poor surgical planning and execution,  and majoritarily abscence of key gestures (missing osteotomies, grafting, etc); however there is a group of non-sense poor cases in which you have no remote idea why the previous surgeon did this or that, applied such graft or performed such maneouver... it seems to me like random attemps to "play with a Guinea's pig and let's see what happens" without any understandable logic.

As rhinoplasty surgeon you have to predict the viscoelastic behaviour of the nose you are operating on, and deem indicated or not any additional suport or re-structuring gestures, grafting, etc.

Surgeons graft-it-all style, surgeons open-them-all style... just convey their own unreliability to their techniques.

Toby Mayer, MD · Answer

Different strokes for different noses and surgeons. I do not use struts myself but many fine surgeons do. Focus on shooting the surgeon whose noses you like and let him worry about how he does it!

Steven M. Denenberg, MD · Answer

Hi,I've been reading your posts, and I don't quite understand why you haven't found a solution yet. In my experience, and there's more than thirty years of that, a columellar strut does not hold the tip up. It does nothing to elevate the tip or support the elevation of the tip. A traditional columellar strut, as I understand it, just sits in the middle of the columella, stiffening the columella, in case the surgeon believes that's important for the nose. I almost never ever use columellar struts.But if you have one, and it's causing a problem, and there's a rock-solid diagnosis that it's the columellar strut, and not something else, that's clicking against some bony object, then the columellar strut can be carved back enough that it can't possibly click anymore. Seems to me, unless your situation is very unusual indeed, that the surgeon doesn't have to skimp on carving back the clicking part. Just get it out. Hasn't someone presented that plan to you yet?

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The best advice you can
receive is from an in-person consultation.   It really depends on your individual anatomy and your surgeon's preferred techniques.  Make sure you specifically look at before and after pictures of real
patients who have had this surgery performed by your surgeon and not just a
computer animation system. 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

Barry L. Eppley, MD, DMD · Answer

The main purpose of columellar struts, particularly of the tip cartilages are taken apart, is to support the projection of the nasal tip after surgery. An open rhinoplasty causes scar contracture and potentially tip blunting long term.

Moneer Jaibaji, MD · Answer

The decision to place a columella strut is base of the findings on examination. If the surgeon feels you need it or it important to place a long term support for the tip then a columellar strut is needed.

Curtis Perry, MD · Answer

Many rhinoplasty patients obviously have under projecting tips that require grafts. Other patients at first glance appear to have adequate tip projection but that projection is dependent on dorsal structures for support. When the dorsum is reduced, as part of removing the bump, the tip will drop in after the surgery and result in an unattractive tip. A good surgeon anticipates this and uses grafting as appropriate to prevent this.

Johnson C. Lee, MD · Answer

A columella strut is not needed in every rhinoplasty but is often used in noses that naturally do not have a lot of tip support (squishy nose when you press on it) or where significant manipulation of the septum or lower lateral cartilages are one which releases a lot of the natural support that a nose has before surgery. Hope this helps!Johnson C. Lee, MD Plastic Surgery

William Portuese, MD · Answer

In our practice, we rarely ever use  a columella strut, since they are rarely indicated.  When the tip of the nose is aesthetically pleasing, it's best to just leave it alone and remove the dorsal hump, and narrow the bridge line. A columella or strut can be used for someone who has a very droopy tip.

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the question and struts add support to an operated nose whose new anatomy would benefit from support.  They are not necessary in every patientDr Corbin

Why is a columella strut used?

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