Are there alternatives to a columella strut that can support a thick skinned nose tip?

Question

Hi, I am 26 year old female and i had a consultation with a doctor who wanted to use a strut in my nose to bring tip support. But as understood by patients who had a strut , it makes the nose stiff as well as less dynamic and sometimes you feel it.Heceforth , i dont want to get this strut. What other things can be done to support the tip of a thick skin nose? I have a bit of a hanging columella and would hate the stiff sharp look a strut provides.

Steven M. Denenberg, MD · Answer

The important question is, What are you trying to change about your nose? This one photo seems to show a nose with a tip that projects strongly forward away from the face, and the tip sits lower than many people might prefer. You didn't say what you don't like about your nose, but would elevating the tip and bringing the nose back closer to your face be part of a desired change. A strut wouldn't help either of those two changes to happen.
I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)
And remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that I discussed here--bringing a nose closer to the face and making a meaningful tip elevation--require advanced techniques, and skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon.  And it also discusses how to take photos that are best for online evaluations.

Celal Alioglu, MD · Answer

Hello you need make a small projection of your nose little need to up tip of the nose and make a straight your septum

Eric M. Joseph, MD · Answer

That said, we use columellar strut grafts in nearly everyone. It's a matter of your surgeon's personal preference, and how he was trained. In my opinion, columellar strut grafts are excellent for adding structural support to the nasal tip. They may click occasionally, but this is an easy office fix when it occurs. C-struts do not cause the nasal tip to become immobilized as a septal extension graft may cause. Hope this helps! Dr Joseph

Ronald J. Edelson, MD · Answer

You don’t need a columellar strut. If your bridge is lowered enough your tip will have enough projection. I haven’t used a columellar strut in years  In mist people they make no sense  I know they are all they rage now but it’s not necessary in most cases.

Jeffrey H. Spiegel, MD · Answer

There are several other options.  You don't look like you necessarily need a columellar strut to me in any case.  Among the other methods are suture techniques, septal extension grafts, cap grafts, etc.  But, importantly, don't worry about the technique.  Focus on finding a doctor whose results you like then let them do their thing.

Suleyman Tas, MD, FEBOPRAS · Answer

Dear Neat1544,
Thankyou for providing your picture for better recommendation
tip support cfan be provided but the usage of a strut graft is dependant on ypour case anbd may differ according to your quality or strenght of your cartilage. if your cartliafge i strtong then sticthing technique woukld be enough. however, in my practice i use anatomical strut graft whihc doesnt give a stiff and hard sensation and the tip is flexible and mobile due to utilization of a closed rhinoplasty technique

Best Regards,
TAS TEAM

Robert Ciardullo, MD · Answer

Rhinoplasty without columella strut: a Columella strut is generally used to support the projection of a tip which is under projected and which has either a week or short columella. It is not needed in a nose with sufficient columella support and sufficient columella length. It is not a matter of the thickness of the skin but of the length and strength of the Cartilage supporting the columella. Your Columella in the photo you show does not appear to be short. The strength of the Cartilage of the Columella cannot be assessed except in person, however many noses that looked like yours can be done effectively without a Columella strut.

William Portuese, MD · Answer

In our practice, we do not use a columella strut due to the issues you mentioned. A closed rhinoplasty approach can accomplish shaving down the slight dorsal hump, lifting the nasal tip, reducing hanging columella, and narrowing the bridge line with all incisions placed on the inside of the nose. Also important to release the depressor septi ligament which dynamically pulls the tip downwards when smiling. Choose your surgeon wisely based on extensive experience producing natural results.

Kenneth R. Francis, MD, FACS · Answer

Dear Neat,
It is a little unclear exactly what your goals are here without full proper photographs and more information.  Septal extension grafting has supplanted columellar strut grafting in many practices now for various reasons.  However, they can also sometimes be a little "stiff."  Try a few more consultations to see if you can get a consensus on which would be preferable.  Good luck!

Are there alternatives to a columella strut that can support a thick skinned nose tip?

Answers (9)

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