Cut the depressor septi muscle or add in a strut graft? Which is better for plunging tip and why?

Doctor Answers 6

Plunging nasal tip

There are a few different ways to shorten the nose that I think are simpler and work better.  I have rarely used a columella strut and don't thin it is a good way to sorted the nose at all.  It sounds like you have already seen at least one plastic surgeon and I recommend going on a few more consults.

San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

Cut the depressor septi muscle or add in a strut graft? Which is better for plunging tip and why?

Hello nearlynatural,
Thanks for your question.
The answer depends on how much plunging tip you need to correct.  If the plunge is mild and only with smiling, cutting the depressor muscle can correct this and give a mild amount of tip elevation.  In some cases, Botox can accomplish this as well.
If you need significant correction and tip stabilization, then a columellar strut graft or other tip stabilizing maneuver would be necessary.
There are risks and rewards for both options that you should discuss with your surgeon before proceeding forward.
I tend to prefer columellar strut grafts because they are strong and far more under my control then a random muscle release procedure.
I hope this helps.
Good luck,
Dr. Shah

Manish H. Shah, MD, FACS
Denver Plastic Surgeon
4.8 out of 5 stars 55 reviews

Tip ptosis

The do different things and it depends on what is seen on your exam.  First, the strut graft is a workhorse in rhinoplasty and is a secure and dependable graft.  It is the initial choice for tip sagging (ptosis).  Secondly, if the tip moves downward with smiling or other facial movements, then cutting the depressor will improve that.  Third, combining both can easily be done and is the best option in many patients.  Best wishes.

David Alessi, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 16 reviews

Columella strut or DSN muscle for plunging tip.

With little doubt the strut is much more effective and likely to provide a more dramatic effect, if needed.  Meet with Bd Certified plastic or facial plastic surgeons to get opinions based on a face to face examination.


Jon A Perlman MD FACS
Certified, Am Board of Plastic Surgery
Member, Am. Society for Aesthetic Plastic Surgery (ASAPS)
Beverly Hills, Ca

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 30 reviews

Plunging Tip

The real answer to your question depends on what you are trying to achieve.  The depressor septi muscle is commonly cut if the nasal tip moves up and down while you are talking or smiling as the muscle is pulling the tip down.  If the nasal tip is plunging down in general all the time, a columellar strut can give it the strength and support to stay elevated.  Please consult with a board certified specialist who can assist you in achieving the results you seek.  3-dimensional computer imaging can help you visualize what you may look like afterwards and serve as an important communication tool with your surgeon.

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews


Thank you for the question and every situation and solution may be different.  So go on some complimentary consultations with experts in your area and be evaluated

Dr Corbin

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 61 reviews

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