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

Question

Revision rhinoplasty. I want a more upturned nose with a scooped look and no more dropping when I smile. The doctor I'm interested in uses the Tongue in groove to build up the septum. Thoughts/advice?

Ronald J. Edelson, MD · Answer

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

Ronald Schuster, MD · Answer

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.

Richard Mark Winters, MD · Answer

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...

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

Answers (3)

More Revision Rhinoplasty Questions

Is it possible to hide visible cartilage graft at the tip of my nose? (photos)

Do Kenalog injections make that big of a difference in the final result? The surgeon refuses to administer them.

How hard is it to rebuild a bulbous round tip?

What can be done about this 3/4 view profile? (Photos)

Follow-up question: Permanent solution to camouflage visible dorsal rib graft?

WE SEND PRETTY
EMAILS