Whats the Difference Between a Columellar Strut and Nasal Spine Augmentation? (photo)

Question

I was and am trying to get the result of whats in the picture. Ive had a premaxillary implant fitted a year ago to improve my nasalabial angle and it has completely ruined my smile, i cant even show my teeth. Plus it still feels a bit uncomfortable and after the swelling subsided the results weren't really that great. I talked to my surgeon about removing the premaxillary implant and having nasal spine augmentation instead, but he recommended a columellar strut, I'm not sure. Any suggestions?

Adam Bryce Weinfeld, MD · Answer

The two do different things but are related

	the "spine augmentation " would essentially be a graft located where your upper lip meets the base of your nose at the columella centrally.  It would make the nasolabial angle less acute and decrease your overly sloped upper lip.

	the columellar strut would help with that a little but would be more directed at tip support (increased tip projection) and and increasing columellar show to a natural / normal level

	if you were to come see me I might suggest both but I think I would stress the columellar strut as the more important of the two .

	other issues need to be addressed two in order to get you close to the simulated post op photo.

William Portuese, MD · Answer

Nasal spine augmentation and a premaxillary implant are basically the same type of implants, usually harvested from either autologous substances (bone or cartilage) or synthetic material (silastic or Gortex). Both of these bring the entire base of the nose forward at the nasal spine area. The pictures that are shown display unrealistic expectations. There is too much augmentation of the nasal spine and bridge that is physically possible to do at the time of the rhinoplasty surgery.

Barry L. Eppley, MD, DMD · Answer

What you are after to achieve your imaged results is tip lengthening with the aid of a columellar strut and tip grafting. Nasal spine augmentation will not increase tip projection but opens up the nasolabial angle which has the benefit of improving a more flattened facial profile.

Steven Wallach, MD · Answer

A columella strut is used to give support to the nasal tip and to help provide nasal tip projection., A spine graft will augment or fill out the lower region of the nose to improve the nasolabial angle in those that have an acute angle.

Peter A. Aldea, MD · Answer

The pair of lower lateral cartilages which shape the openings of the nose and create the nose tip sit on the nasal spine. Augmenting the nasal spine fills a recessed , pushed in angle between the columella and the lip but does not lift the nose tip. To do so and get the appearance your "after" photograph demonstrates would require a columellar strut. However, this strut will not fill in the angle between the columella and the lip. You therefore may need both.

	Good Luck.

	Peter A Aldea, MD
	Memphis, TN

Whats the Difference Between a Columellar Strut and Nasal Spine Augmentation? (photo)

Answers (5)