It sounds as though this particular symptom from the graft has localized to an area... as it sounds as though it is persistent it may be worth a limited revisional procedure... best of luck
A columellar strut graft should not move. These grafts are an excellent way to give projection, but they should stay in place. If your graft is moving, it is not sewn in sturdily. This could be revised, more than likely without decreasing projection. Tertiary rhinoplasties (third-time rhinoplasties) are detailed and complex, but are common for those of us expert in revision rhinoplasty.
The columellar strut can be revised only in its inferior part that sits on the nasal spine and causing your discomfort. The existing scar tissue will hold the tip along with the remaining strut. Get it fixed. RegardsDr.J
Depending upon what the strut is doing for you will depend upon the post-op ramifications. If you shorten the base so it does not click, it may cause the projection to diminish. Hard to say without an exam.
Hi. I disagree with the 2 prior responses. If the strut is shortened to the proper length so that it is still giving good support, but not long enough to flip back and forth over your nasal spine which is what is happening now, then all will be good. This is a simple issue to fix. Good luck.
Thanks for your question. If this is your third revision, just make sure you are getting at least 3 opinions from revision rhinoplasty specialists and take your time. There are ways to shorten the strut and keep the nose projected though it would require opening the nose again and little more work. If you try to shorten the strut, without doing anything else to reproject the nose, then it could drop mildly. I would try to shorten the strut and at the same time have a plan to reproject the nose to stay close to where you are now.
I have never been a big fan of putting struts in every nose I do. I am a minimalist therefore I try to work with whatever the patient has and use a strut very rarely. I have been doing rhinoplasty surgery over 32 years and have found very few patients that need a strut. I think you probably can remove your strut and suture the medial feet of you Columella together for support. Naturally you would have to be evaluated to determine other factors.