What's the healing process like for getting tip projection with only a columellar strut? Is swelling as bad as an osteotomy?

Generally, performing an osteotomy will likely make you have more swelling in your nose initially. However, the swelling tends to resolve from the top down meaning the tip is the last area where the swelling resolves. Thus, manipulating your nasal tip after septal cartilage harvest only versus tip manipulation with osteotomies may not have much difference in the longer term in terms of how quickly the swelling resolves.

In regards to the incision, this depends on whether your surgeons performs your surgery via an open or closed technique. The open rhinoplasty means you would have an incision through the columella, but this scar heals so well it is very difficult to see, even close up.

A columella strut is used to give tip support and prevent the tip from falling so much during smiling. To obtain projection, a tip graft is placed on the domes or tip cartilage angle. Osteotomy's are the most traumatic event while performing a rhinoplasty but when necessary to give the best results should be performed.

African american rhinoplasty typically involves 4 different components. Some patients need them all, some only one or two. Here are the 4 components.
1. Improvement of the bridge height with an implant.
2. Narrowing of the wide upper nose (bony part) with osteotomies.
3. Narrowing of the tip (Tip-plasty)
4. Narrowing of the nostrils (Alarplasty)

You only need step 3. It can be done with closed approach and there will be no incision on the outside.

Regards
Dr. J