Does a longer columella strut provide more tip support than a small one?

Question

Does a longer columella strut provide more tip support than a small one because I do not think so. If a columella strut is a regular size it gives support... if it is a long one and say it goes down to the nasal spine how does that extra length at the base of the strut give more support? I am just confused because I think they would give equal support. I ask this because my strut had to be trimmed in a revision and am curious with the anatomy?

Robert Morin, MD, FACS · Answer

There are different kinds of columellar struts and some are more powerful that others. In general, columellar struts are placed in order to MAINTAIN tip support, height and projection. If they are not used, postoperative tip collapse can occur. Larger struts that are fixated to either the nasal spine/maxilla or the septum will be more "powerful" than smaller struts that are "floating" in the soft tissue.

If one is aiming to drastically INCREASE tip support, height or projection, however, a septal extension graft should be used instead of a columellar strut.

If one is aiming to drastically INCREASE tip support, height or projection, however, a septal extension graft should be used instead of a columellar strut.

Afshin Parhiscar, MD · Answer

Dear ElizabethNot all columella struts are placed for the same reason and they are not all the same shape and span the same distance. Also, the surgeons approach and training impacts how they utilize cartilage grafting. In my experience, a longer strut is used to increase projection and rotation beyond the natural position of the tip. It often produces a more unnatural appearing nose. A proper length strut will support the tip at its proper position and create a long lasting structure with stability. In deviated noses, the strut is often secured firmly to the nasal spine and then extended to meet to caudal end of septum to bring it midline, hence a longer strut. In a basic rhinoplasty, a shorter graft is often sufficient. Clicking can occur because of many reasons, however, It sounds like your revision was successful. Happy Holidays!

Steven Wallach, MD · Answer

First, not all surgeons use columella struts in all cases. Some are put all the way down to the spine when a surgeon feels the patients needs maximal tip support and projection, and some do not.  Columella struts can "Click" against the nasal spine especially when the tip is pushed in.

Arian Mowlavi, MD, FACS (license on probation) · Answer

Strut graft length and depth of positioning is an art and requires judgement over tip support, tip weight, tip position, which will determine above measures.

Does a longer columella strut provide more tip support than a small one?

Answers (4)

More Revision Rhinoplasty Questions

Dangerous to have septal perforation?

Removing a callus/bony bump from the bridge of the nose.

How much volume/bulk will a temporal fascia graft add to the tip of the nose?

How close to my old nose can I get with revision rhinoplasty? (photos)

Skin tear after Rhinplasty. Caring for wound. (photo)

WE SEND PRETTY
EMAILS