Tongue in groove vs. columellar strut graft for tip rotation and support?

There are simple ways to correct a nose that is either too long or has a hanging columella. Unfortunately many surgeons take a more complicated route of correcting this involving cartilage grafts. That’s rarely necessary in most cases

The relationship between the tip and the dorsum gives the nose its distinctive character. Most surgeons and patients prefer to have the tip slightly above the dorsum. The tip must retain enough support to maintain that position. Sometimes the tip cartilages have enough strength on their own. Other times it needs help either with a columellar strut or using a tongue in groove technique. A good rhinoplasty surgeon can use either.

Tongue in groove is merely a technique whereby caudally displaced medial crura of the lower lateral cartilage are suspended from the caudal septum to bring the columella cephalad... there are relatively narrow indications for this, the caudal septum must be adequately positioned, etc.

Tip projection and rotation can be defined and controlled by structural grafting.... although there is room for debate and surgeon preference plays a role, I have adopted septal extension grafting in lieu of columellar strut grafting because of its greater reliability and strength

Good luck...