Any suggestions for weak tip cartilage?

Your problem is an common one, and unfortunately often unrecognized until too late.  The actual issue seen when a doctor examines you is weak 'tip support', which can be caused by a number of things, including weak tip cartilages, poor attachments to the septum, and several others.  The way to address this issue is to strengthen tip support. There is not a simple answer to this, as the technique used would depend on (a) the cause, which can only be determined definitively at the time of surgery and (2) what you're trying to achieve cosmetically.  Depending on these two factors, a variety of techniques are available and all have their place.  I will say that in the instance of weak tip support, an external (open) approach allows better evaluation of the issues and more options for treatment.  The decision on approach, however, is between you and your doctor.Hope this helps.

There is no substitute for your own cartilage. A columellar strut is a way of ensuring that the tip maintains projection to counteract gravity.  In addition many of us have come to use subdomal grafts of cartilage (doubling up the thickness of each side of the tip)  either using excess existing tip cartilage or borrowing from the septum (inside the nose ) or from the ear. 

 In our practice, we rarely put columellar struts in. We have taken many of them out when they have been placed elsewhere. There are many types of grafts that can add strength to the tip such as alar batten grafts, alar rim grafts, and suture techniques applied to the lower lateral cartilages of the nasal tip. All of these techniques can be performed with either closed or open rhinoplasty, depending upon the surgeon's preference

There are several grafts that can strengthen and add projection to the tip area. Strut, onlay and batten grafts from the septum, ear or rib. I have done many struts through a closed tip but there are times when an open approach is a better option. 

Hello Sarasen,Thank you for your question.  Every surgeon has their own preferences, but in general, when operating on the nose, we want to leave structures intact and rebuild the main supporting structures.  If you start with weak lower lateral cartilages, then you need support.   A columellar strut is a basic component to closed and open rhinoplasty, so it does seem a little odd that you were told this.  Anyways, you need to trust and believe in your surgeon.  Best of luck!

There are several ways to support weak tip cartilages. In addition to columellar struts I use sutures between the medial crura of the lower lateral cartilages and the septum, and septal extension grafts to establish and maintain tip projection. Rather than worry about the specific technique have the surgeon show you long term results in patients with your problem. An experienced can easily do that.