If you take out a columella strut graft will columella lower? (photos)

Question

My primary surgeon told me that he placed a strut graft it my columella to keep the tip up, however I never had a hanging columella and he pulled it back and tucked it in making my columella look retracted. I want my little pointy tip back. If I take out the strut graft, and add and extension graft, can my columella come down again? I don’t want a straight/flat columella either.

Ronald J. Edelson, MD · Answer

I have been very unimpressed by the columellar strut that seems to be in fashion these days. It appears to serve no purpose but can feel uncomfortable and distort your tip. I have taken many of them out with no complaints

Eric M. Joseph, MD · Answer

Based on your photos, you may have a "poly-beak" where your bridge projects further than your tip. Removal of a columellar strut may not lead to increased nostril show. Revision rhinoplasty may be considered for achieving a more pleasing nasal profile appearance. 2-4 mm of nostril show on profile is considered normal. I do not think your columella is terribly, unattractively retracted. Hope this helps. Dr Joseph

Nima Shemirani, MD · Answer

Dear Sociable,

How far out are you from rhinoplasty? If it has not been at least 12 months, it is best to wait and this can improve. If not, there are a couple of ways to bring the columella down including a septal extension graft, or a larger columellar strut or a plumping graft.  The tip will also become more pointy with time.

Best regards,
Dr. Nima

Steven J. Pearlman, MD, FACS · Answer

The goal of rhinoplasty (and revision rhinoplasty) is to get a balanced nose that you like and also one that can be surgically achieved. It is difficult to say exactly what surgical maneuvers would achieve your goals from these photos. You do mention some of the common techniques used in both primary and revision surgery. You should see an expert in revision rhinoplasty for a full examination where they can examine your nose inside and out and touch it to see what structure you have. Then a full discussion can be had about how to get a better nose.

Thomas A. Mustoe, MD, FACS · Answer

A columellar strut is extremely useful to maintain desired tip projection during healing process.  A septal extension graft does as well. Removing a strut will likely result in loss of tip projection as causing bowling or hanging of the columella.  A better approach to removing would be to adjust with changing position of graft or adding more graft.  The healing process is active a d dynamic and extra support is required for predictable results.

If you take out a columella strut graft will columella lower? (photos)

Answers (5)