L strut concern. If you remove too much septum, you can have saddle nose or collapse. How can I rhinoplasty increase strength?

Question

I was told after a rhinoplasty your nose is as strong or stronger than pre op... What I do not understand is if I have only a 1cm l strut. If i was born with a full septum how can a L strut be stronger or same strength if I have very little septum left. If you remove too much septum you can have saddle nose or collapse so how can a rhinoplasty increase strength? Can a doctor explain this?

Roger Tsai, MD · Answer

Great question!  The 1cm strut is the minimal required to have a stable nose, any less than this you risk having a saddle nose deformity, which pretty much means the "strut" has collapsed.  Having a full septum provides more support and prevents collapse - this is why I rarely do L-struts, I try to maintain as much septum as possible and only remove what I need for grafts or to assist in creating a straighter nose.  Once the healing process kicks in, the scar tissue that is created will form some stability to the nose, but it wouldn't be stronger than it was before.Often times these details are better explained and understood with an in person consultation.  Best of luck, hope this information helps!

Jonathan Cabin, MD · Answer

This is a great question.
You are correct that the creation of an L-strut does not increase strength - however, several studies have shown that a septum only needs 8-10mm of an L-strut to maintain the necessary structure to the mid-portion and tip of the nose.
Without knowing your particular case, I can't comment on your nose. But a rhinoplasty can generally INCREASE nasal strength if the cartilage removed from the septum (or taken from other parts of the body - like the ear or the rib) are used as grafts in places that may be weak within the nose. Basically, you are taking excess cartilage from the septum and using it to strengthen another part of the nose. Certain types of permeant stitches and scar tissue can also strengthen the nose.
Hope this helps! Best, Dr. Cabin

David Alessi, MD - Account Suspended · Answer

The experience of a lot of surgeons over the past several decades makes it clear that the risk of a saddle deformity is very low if a 1 cm "L" -strut if left.  Also, the lining of the cartilage, if left in place, will grow some new cartilage.  Additionally, most qualified surgeons will leave as much cartilage in place as possible and actually underlay the flaps with morselized cartilage or bone towards the front.  After a month or so, the nose will have nearly the same structural integrity as a virgin nose. However, I don't know of any literature to suggest the nose being stronger after a rhinoplasty.  Best wishes.

Jon A. Perlman, MD (retired) · Answer

When nasal bones are infractured and/or when septum is resected there is less integrity and strength than normally exists.  The L strut dimensions are a minimum recommendation to maintain support, it does not add to it.Regards,Jon A Perlman M.D., FACSDiplomate, American Board of Plastic SurgeryMember, American Society for Aesthetic Plastic Surgery (ASAPS)ABC-TV Extreme Makeover SurgeonBeverly Hills, CaliforniaIG: jonperlmanmd

L strut concern. If you remove too much septum, you can have saddle nose or collapse. How can I rhinoplasty increase strength?

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Answer: L strut concern. If you remove too much septum, you can have saddle nose or collapse.

Answer: L strut concern. If you remove too much septum, you can have saddle nose or collapse.

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L strut concern. If you remove too much septum, you can have saddle nose or collapse. How can I rhinoplasty increase strength?

Answers (4)

Answer: L strut concern. If you remove too much septum, you can have saddle nose or collapse.

Answer: L strut concern. If you remove too much septum, you can have saddle nose or collapse.

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Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.