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?

Semih Yildiz, MD, FEBOPRAS · Answer

A columellar strut is a cartilage graft placed between the medial crura to strengthen tip support and help control projection or rotation. As a standalone operation, it is most appropriate when the bridge, septum, nasal valves, nostril base, and tip shape are otherwise acceptable and the main problem is limited weakness or mild tip droop. It may also be considered for a small secondary correction when the prior rhinoplasty is otherwise stable.

Local anesthesia with oral or IV sedation can be reasonable for a short, limited procedure in a healthy, cooperative patient, depending on the surgeon and facility. Cartilage still has to be obtained—often from the septum or ear—and the surgeon must decide whether the graft can be placed through an internal incision or needs open exposure. If the tip cartilages require major reshaping, the caudal septum is abnormal, the nose is significantly asymmetric, or breathing problems are present, a strut alone is unlikely to be sufficient.

Possible tradeoffs include excess stiffness, visible or palpable graft edges, altered nostril shape, asymmetry, infection, displacement, and an unintended change in projection or rotation. An in-person examination is necessary to confirm that the concern is truly isolated and that a more complete tip or functional rhinoplasty is not required.

Donald Groves, MD · Answer

Hello and thank you for your question. Unfortunately, a minimal procedure or surgery "just to the tip" or "just to the columella" will not be able to fix your issues, and should never be performed as a standalone procedure due to the extreme complexity involved in such maneuvers and the guaranteed asymmetry and distortion that would result- any surgeon that tells you otherwise is either inexperienced or is intentionally doing you a huge disservice. A rhinoplasty can best address your aesthetic concerns and any functional issues with your nose. I would be able to adjust the size, shape, and especially the definition of your nose (particularly the tip), improving your overall facial balance. I'd also be able to open up and solidly reinforce the underlying structural framework of your nose (to prevent distortion and retraction from scarring forces over time)!

Rhinoplasty truly is a surgery of millimeters- and whether you're looking for a minor adjustment or a major transformation, it requires exceptional surgical skill to achieve functional and natural-looking results! Because your nose is the DEFINING feature of your face- I would only recommend seeing a surgeon who specializes in rhinoplasty procedures, and who has significant training and experience performing these surgeries. I actually trained under one of the world leading rhinoplasty experts (who performs 1,000+ nosejobs annually).

If you are unhappy with the appearance of your nose, I recommend for you to setup a formal consultation with me (or another plastic surgeon who is extremely comfortable with rhinoplasties) to thoroughly discuss your surgical goals, undergo a formal examination, evaluate your options, and develop a personalized plan just for you. I hope this helps!

Dr. Donald Groves
Aesthetic Plastic Surgeon

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 (8)

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