Columellar Strut - When is It Necessary?

Like with so many things in life, the answer is, "it depends." Tip drop after rhinoplasty can occur with or without the use of a strut graft so using one is no guarantee of a good outcome and struts can have their share of complications, too (over-projection, warping, clicking, widening of the columella, etc.). I don't always use them if I'm stabilizing the tip in other ways, but I do make sure to stabilize the tip one way or another. I usually recommend that patients follow-up with their surgeon regarding these concerns .

Good luck,

--DCP

The columellar strut is one of the most overused and unnecessary things in rhinoplasty. It truly serves no purpose and many surgeons put one in fir no real good reason. Beyond that many columellar struts feel hard and are uncomfortable to the patient and are best off being removed

Hi Forest Hills in Forest Hills, NY,

A columellar strut is a cartilage graft that is placed at the base of the nose, in between your natural lower nasal cartilage. The columellar strut can help keep the nose straight, project the tip, and stabilize the tip. Columellar strut is a more common cartilage graft as compared to the many other rhinoplasty grafts available.

Rhinoplasty is not one operation, but rather many potential operations. Each plastic surgeon may have different approaches for the same patient. Some surgeons may use cartilage grafts more often than other rhinoplasty surgeons. There isn't one correct rhinoplasty, but rather many good rhinoplasty options for each person. Speak with your rhinoplasty surgeon regarding any concerns you may have.

Dr. Chaboki

During most rhinoplasty surgeries, I will harvest, sculpt and place a columella-strut. These cartilage grafts measure 3-4mm (width)X20-25mm (length), and are sutured in between your tip cartilages. Columella-struts add tip support, maintain tip orientation, and lead to a more durable nasal tip.

Most nasal tips "come down a bit" during the early post-operative course. If you're concerned by the appearance of your nose, you should consult your surgeon.

I hope this is helpful for you.

Rhinoplasty is a complex procedure. Even among experts there is often disagreement on what is the best procedure for an individual. So it is difficult for a lay person to decide between two surgeons what is best for them. What you should do is see who you feel most comfortable with and as long as they are a rhinoplasty expert, let them do what they feel will give you the most aesthetic result. What you should not do is compromise since you have one nose and hopefully have on operation that will last you for the rest of your life.

As a facial plastic surgeon, I perform my septorhinoplasty by the open approach. I usually harvest a strut graft from the septoplasty portion of the procedure. I prefer using the patient's cartilage rather than an alloplastic material. Depending on the approach (open vs endonasal), once postoperative swelling resolves, your tip might drop slightly. Other maneuvers such as dome suturing can narrow and project the tip and if these were not performed, your tip may appear like it dropped. I always place a strut graft to support the tip and prevent potential tip migration. It is difficult to answer whether lack of a strut graft resulted in what you see regarding tip position. Discussing with your surgeon what he/she performed would be my initial recommendation. I would enjoy entertaining any further questions once you know everything that was performed. Good luck.

 

Dr. Randall Latorre

The columellar strut is a small cartilaginous graft harvested from the inside of the nose and is used to prop up a very droopy nasal tip. It is one small technique in a variety of procedures to try and bolster nasal tip projection and prevent sagging. Not all surgeons will agree on a given nose as to whether or not a columellar strut needs to be placed. Columellar strut does tend to make the tip quite stiff after the surgery. The relaxing of the tip in the downward position varies with each nose and depends on the techniques done at the time of surgery. Sometimes a small touchup can lift the tip up, but it is best to wait at least one year after the initial rhinoplasty.  

Regarding: "Columellar Strut - When is It Necessary?
I recently underwent rhinoplasty (a few months ago) and my doctor did not put in a columellar strut. During the initial consultation, I had mentioned to her that another plastic surgeon had recommended a strut (I didn't use that doctor because he was too expensive) but she insisted that I don't "need" it. Now I am noticing that my tip came down a bit...is it because a strut was not inserted?"

In general, a Strut Graft is used very much like a weight bearing column is in home construction. It is used to support the tip complex and in some cases lift it over the profile of the dorsum of the nose adding height. It can also be used for other purposes which need not be discussed here.

Without having examined you before and after your surgery or seen your before and after photographs, it is truly impossible to say if a strut graft was "necessary" or advisable in your case. Plastic surgeons often disagree on the surgical paths each will take to achieve the same cosmetic goal.

Dr. Peter Aldea

I do not always use a strut. When I first started doing rhinoplasty ( open) i used them all the time. I found it was not necessary in most cases. In fact, I found that the strut sometimes widened the columella too much for my taste.  The tip dropping may or may not be related to the columella strut not being used.

A columellar strut is just one method of maintaining or increasing nasal tip projection. Other techniques such as tip grafting and various suture techniques are also effective, and each surgeon has his or her favorite methods. Following rhinoplasty, the nasal tip almost always drops a bit no matter what technique is used.  The question is, do you feel that your tip is now too low?  If so, discuss this with your surgeon.