When is a columellar strut used as a standalone procedure without full rhinoplasty?

Question

In what situations would a columellar strut–only tip support be performed as a standalone procedure under local or IV sedation?

Lucian Ion, FRCS · Answer

A columellar strut, or a septal extension graft, both represent methods of providing additional support to the nasal tip by reinforcing the existing tip cartilages. However, placing a cartilage graft between the native tip cartilages on its own does not reliably transmit strength to the surrounding structures and, in isolation, can create more problems than it solves.

A strut-only approach could be considered only in very select circumstances, typically in a revision rhinoplasty where the tip cartilages have already been reshaped and securely stabilised, and additional support is required to help maintain projection. In such cases, a partial release of the tip cartilage attachments may allow the introduction of further structural support.

That said, this is not a common or predictable intervention, and most rhinoplasty surgeons would be cautious about adopting this approach because of the difficulty in reliably forecasting the outcome. In general, I would advise against it.

Eric M. Joseph, MD · Answer

A Columella strut graft is a piece of cartilage, about the size of a Matchstick. It is utilized to add structural support to somebody's nasal tip during rhinoplasty surgery, and I am not aware of it being used as a stand-alone treatment, without other necessary modifications being necessary. I hope this helps. Sincerely, Dr Joseph

Zoran Potparic, MD · Answer

Columella strut graft is usually used for tip support to correct low positioned, droopy tip, as well as for some columella deformities. In the case that your surgeon is using graft from fresh frozen cadaver cartilage, this procedure can be done in local or MAC anesthesia. Harvest of the graft from septum would require MAC or general anesthesia. Good luck.

Tanveer Janjua, MD · Answer

It is used to lift the tip and increase the projection as a stand alone procedure using septal cartilage, ear cartilage, implant or rib. 
I use ear cartilage to lift and works great.

Regards
Dr. Janjua

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. What you are describing would not work well and would almost certainly end up with a revision. Structural rhinoplasty needs to be performed the right way for a good longterm result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Sean Fisher, MD · Answer

This is not something that I would perform for the purposes of tip support. The purpose of a columellar strut graft is to support the position of the tip. In rhinoplasty surgery, where the goal is to increase tip rotation, the lower cartilages of the nose which help determine tip position are freed from the overlying tissues, reshaped, repositioned, and finally supported (often with a columellar strut graft). Simply adding a cartilage graft in isolation is unlikely to yield a meaningful result if the goal is to adjust tip position. I would recommend consulting with a plastic surgeon with advanced training in rhinoplasty to assess your anatomy and recommend a plan that fits your goals.
Sean Fisher, MDAesthetic Plastic SurgeonSeattle, WA

When is a columellar strut used as a standalone procedure without full rhinoplasty?

Answers (6)

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