Shortening columella strut? (Photo)

Question

I will be having a revision for a columella strut that is sometimes palpable and that gets caught on something. it is very uncomfortable and I cannot live like this nor did I pay for a problem. I am very worried though. Will trimming this strut make my tip droopy. I have dome sutures and onlay graft and shield graft though..? Does the columella strut directly increase the tip heigh and projection or just "strength". I am very worried because if it droops down then my nasal bones will show :(

Christian L. Stallworth, MD · Answer

Strut length (height) and position can lead palpability and "clicking" when it encounters the bone of the nasal spine.  The strut does serve all of the purposes you mentioned though.  It helps with tip support, projection and rotation - therefore, altering the strut may impact each of those aspects of the nasal tip.  Please discuss these concerns with your surgeon so that you are both on the same page about your desired outcome.Good luck.

Adam Bryce Weinfeld, MD · Answer

Yes it can be made shorter.  Yes that should help with it catching on the bone above your teeth on you maxilla (the anterior nasal spine).  Yes that might decrease tip support.  But, there are ways to counter act that.  Also, you dorsum is still a little over projecting.  Reducing that would make any loss of tip support less of an issue.

Robert Kotler, MD, FACS · Answer

Dear apple1937 in Beverly Hills,
California:

Wow, you have a lot going on there.  If the strut is causing an unsatisfactory
appearance and breathing problems, then of course there has to be some revision
surgery done there.  Particularly because
it is uncomfortable, you want to get this done. 
Regarding whether or not turning the strut will “make my tip droopy,” it
is hard to say without feeling it.  Dome
sutures and onlay grafts and shield grafts are done to strengthen the tip, and
hopefully some manipulation or partial removal of the strut will not compromise
the strength of that part of the nose.  The
surgeon will be able to figure that out. 
You asked whether the columella strut directly increases the tip height
and projection or just strength, and my answer is that frankly without feeling
it and carefully examining it, I can’t answer that questions.  Your concerns are valid.

You need to have consultations with
surgeons who are highly focused on nasal issues, both surgical and non-surgical.  It may be that you can be helped by a
combination.  Sometimes that is necessary
to get the optimal result.  When you go
for consultation, be sure to have computer imaging.  Likewise, prepare for the consultation by
composing a written list of questions.  You
want to stay focused and help the doctor address all the issues that concern
you.  Be sure to bring your operative
reports and photographs taken before and after the prior procedure because that
is going to be very important to the surgeon to understand what has been done,
why it was done, and how it was done.

Review a lot of websites as you decide
which surgeons to consult with.  You
should see a large collection of before and after photos including primary
rhinoplasty, revision surgical rhinoplasty, non-surgical rhinoplasty, and
non-surgical revision rhinoplasty.  You
want to be in the hands of someone who has a broad range of talent using all
the modalities available.

Bring a friend or family member because
there is going to be a lot to discuss and you don’t want to have anything
missed.

Best wishes,

Robert Kotler, MD, FACS

Over 4,500 nasal procedures performed

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

What you show in the first picture it your anterior nasal septum; this has nothing to do with your columellar strut graft; in fact, you show some supratip fullness that should be resected and your nasal tip support structures should not be compromised.

Shortening columella strut? (Photo)

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Answer: Columellar strut trimming?

Answer: Columellar strut trimming?

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Shortening columella strut? (Photo)

Answers (4)

Answer: Columellar strut trimming?

Answer: Columellar strut trimming?

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Everything you need to know about Revision Rhinoplasty

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