Rhinoplasty: Columella strut the only way to lift the tip of the nose?

Question

dear doctors is a columella strut the only way to augment the tip of the nose? every surgeon that i visited suggested columella strut to lift the tip of the nose, but i have had bad experience on myself and seen on my friends with columella strut because every time the tip of the nose would sink/droop 1 year afte surgery. My question is : are there other techniques besides the C.S. to lift the tip up? is that technique more effective than the columella strut? good results so far? thanks

Thomas A. Lamperti, MD · Answer

Yes, there are other ways of supporting the tip after rhinoplasty besides using a columellar strut. Septal extension grafting and extended spreader grafts are possibilities along with using a tongue in groove setback technique. Any of the above techniques can work well in my experience. The best method to use depends on what if being done and your specific anatomy and sometimes more than one method is used.

Toby Mayer, MD · Answer

Other ways to elevate tip without columellar strut?  yes.  For more than 35 years I've never used columellar struts to elevate the tip. The results can be seen on my website and those of others.  This avoids the many complications and annoying problems associated with columellar struts.

Manish H. Shah, MD, FACS · Answer

Hello,
Thanks for your question. Columellar strut grafting is very effective for projecting and repositioning the tip. You can also do this with columellar-septal suturing, caudal septal extension grafting, and extended spreader grafting. Each has its own reason to be used. Work with an experienced rhinoplasty specialist for the most personalized surgical plan.
Good luck,
Dr. Shah

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. The best advice you can receive is from an in-person consultation. One alternative option to lift and stabilize the nasal tip is with a caudal septal extension graft.  The best option for you will depend on your nasal anatomy.  Make sure you specifically look at before and after
pictures of real patients who have had this surgery performed by your surgeon
and not just a computer animation system. The most important
aspect is to find a surgeon you are comfortable with. I recommend that you seek
consultation with a qualified board-certified plastic surgeon who can evaluate
you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

William Portuese, MD · Answer

In our practice, we have abandoned using the columella or strut due to complications that we have seen from it. There are many different techniques available to the rhinoplasty specialist to lift the nasal tip cartilages. For more information  and many examples, please see the link and the video below

Mark B. Constantian, MD, FACS (retired) · Answer

Columellar struts arose because surgeons using open rhinoplasty needed something to stabilize the lower nose so they could restore the support that is lost by opening the nose. Then someone decided that they actually increased tip projection, although subsequent research in the literature has given conflicting answers. Some surgeons have even abandoned using columellar struts because they are unreliable in producing tip projection.However, normal noses with attractive tips do not have columellar struts. The best surgical correction is always simulating what Nature does. Good tip projection comes from the center of the tip cartilages (called the middle crus), which determines the shape and projection of the tip. If patients have poor tip projection, the middle process is too short. That is why augmentation of the middle crus with tip grafts very reliably increases projection. Tip grafts can be used for contour or projection or both, and can be altered to produce rounder or more angular tips, depending upon patient aesthetics. That is why there are so extremely valuable and why I use them in virtually every rhinoplasty.

Richard W. Fleming, MD (retired) · Answer

Depending on your needs the nasal tip can be elevated without a columellar which I rarely use. I prefer tip rotation, tip grafts, suture placement, or septal extension grafts to increase tip projection or elevation

Rhinoplasty: Columella strut the only way to lift the tip of the nose?

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