Tongue-In-Groove Vs. Cartilaginous Columellar Strut?

Why would you use Tongue-in-Groove vs. Columellar Strut? What is the difference, what outcome, and which technique is better? When and why would you use one technique over the other? Do both techniques produce the same or similar results? Would you do Tonque-In-Groove on someone who had septoplasty 20 years ago? Thanks in advance!

Doctor Answers 14

Tongue in Groove and Columellar Strut in Rhinoplasty

   Columellar strut can be used for tip stabilization and can be fixed to the anterior nasal spine or left floating sutured to the medial crura.  This can help with maintaining projection or improving projection.  The tongue in groove involves suture fixation of the hanging columella medial crura to the septum.  Kenneth Hughes, MD Los Angeles, CA

Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Tongue-In-Groove vs Columellar Strut

The main difference lies in fixation of tip cartilages onto the septum in the tongue-in-groove technique, which in theory can provide a better long term support of the tip. However, there are many nuances in making a determination with which technique to proceed. History of previous septoplasty surgery, and the remaining size and shape of septal cartilage, can certainly influence this decision. Both techniques can help with tip rotation and projection, and selection of which technique to use depends to a large degree on findings during surgery. Good luck,


Grigoriy Mashkevich, MD

New York Facial Plastic Surgeon

Grigoriy Mashkevich, MD
Manhattan Facial Plastic Surgeon
4.7 out of 5 stars 10 reviews

Surgical techique in rhinoplasty is very dependant on the patients anatomy as well as personal preference of the surgeon

Both columellar struts and tongue in groove are ways to support a nasal tip as well as rotate or increase tip projection (how far the tip stands out from the face). I use columellar struts much more often but there are certainly times when i prefer tongue in groove as well. Either may be applicable and really depend on a comprehensive evaluation and treatment plan from a rhinoplasty specialist.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 125 reviews

Columellar strut

  Columellar struts are occasionally used when patients have very ptotic tips.  They are not used in the majority of rhinoplasty surgeries.There are multiple techniques such as tongue in groove and cartilaginous  columellar struts.  The  struts  may or may not be sewn to the tip cartilages when necessary.The decision on which technique to use is made at the time of the surgery by your rhinoplasty surgeon. After having had a previous septoplasty, the bigger question will be  where to obtain cartilage for grafting purposes. You may have a cartilage depleted nose, therefore ear cartilage or rib cartilage may be needed.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Tongue in Groove vs. Columellar strut

You have very good questions but I must agree with Dr. Menachof. The decision on what technique to use in order to give you the results that you are looking for should be left up to your surgeon. Do not micro-manage your surgery. Choose your surgeon based on the results and common understanding that you both have in what your goals are and your surgeon's ability to deliver. I think that it is fine to discuss these questions during your consultation after your surgeon has been able to examine you and give you the best advise. Good luck.

Ronald Schuster, MD
Baltimore Plastic Surgeon
4.9 out of 5 stars 77 reviews

Columella struts and tongue in groove

A tongue in groove procedure is when the columella is brought up to the caudal septum and secure. This can be used for hanging columella. A columella strut is used for support.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Tongue-in-Groove Vs. Strut Is Not The Question You Should Be Asking

You have received some very good answers to your question from my colleagues. There are some very good descriptions of the differences between the techniques so I won't add to that. My question to you (without meaning to be harsh) is why do you care? You aren't going to choose a rhinoplasty surgeon because he or she does a great tongue in groove operation. You are choosing him or her (at least I hope you are) because their rhinoplasty results look great. The art of doing a great rhinoplasty is not in knowing how to do a particular technique, but in knowing which technique is the best option in a particular person. Great rhinoplasty surgeons have a toolbox full of techniques. The key is knowing which of these techniques you are going to pull out of that toolbox in a specific patient. And although we often have a good idea going in to the surgery which tools we are going to use, sometimes once you can see exactly what the issues are you will change your mind  and go in a different direction. With this in mind, the important thing is not whether your surgeon likes one better than the other, but rather can they use either of these options (or for that matter 3 or 4 others) if need be. This is the difference between a technician and an artist. Good luck in your journey.

Michael R. Menachof, MD
Greenwood Village Facial Plastic Surgeon
4.4 out of 5 stars 26 reviews

Columellar struts are useful for providing tip support during Rhinoplasty Surgery.

In my practice, columellar struts are placed nearly routinely during Rhinoplasty Surgery. Columellar struts typically measure 25mmX4mm, and are placed in a pocket between the medial crurae of your lower lateral cartilages. This added cartilage adds strength and longevity to the position of your tip.

A tongue-in-groove technique refers to suture-fixating the medial crurae of your lower lateral cartilages to the bottom of your septum. This technique may be used to lift your tip, rotate your tip, or correct a hanging columella.

Hope this is helpful for you.

Dr. Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 418 reviews

Whether to use tongue-in-groove versus columellar strut technique

Hello renap1,

The decision on whether to use a tongue-in-groove technique versus a columellar strut is based on the specific situation and anatomy that you have. Both are excellent methods of stabilizing and securing the nasal tip cartilages during rhinoplasty.

The tongue in groove technique works well if the caudal septum is already very long (and in the midline). In some people the medial crural cartilage that make of the coluemlla are already overlapping the septum. It also works well if there's hanging columella and the surgeon wants to elevate the columellar position.

The columellar strut technique works well in cases where the septum isn't already overlapping the medial crura. Ideally, the strut shouldn't change the position of the columella.

You can check out my web reference link below to learn more about hanging columella repair (and determine if you have a hanging columella to begin with).

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 21 reviews

Tongue-in-Groove technique vs. Columellar Strut

Thank you for the question. This is certainly an advance and technical point, and requires a lot of time and detail to explain. In general, each technique is used to stabilize the tip.  The tongue-in-groove method, however, can be used to rotate the tip of the nose up. A columellar strut generally does not result in tip rotation, or in some cases, can rotate the tip down slightly. A rhinoplasty expert can meet with you to discuss these and other techniques specifically in reference to your nose.

Evan Ransom, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 110 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.