The role of the columellar strut in rhinoplasty: indications and rationale

Rohrich RJ, Hoxworth RE, Kurkjian TJ.

What this paper says

This article defines when and how to use a columellar strut, a hidden cartilage rod between the tip cartilages, gives a decision algorithm, and draws on a 15-year review of the senior author's cases; the abstract reports no counts.

Overview

Nasal tip surgery uses two families of tools: sutures that reshape the cartilage and "invisible" grafts placed beneath the surface. The columellar strut is the most used invisible graft. The authors set out its role in primary and secondary open rhinoplasty, describe correct placement, offer a clinical algorithm and review the senior author's (R.J.R.) 15-year experience.

Sections of note

Review with a 15-year retrospective analysis of one surgeon's practice; the abstract gives no patient numbers, outcomes or complication rates.
The columellar strut is described as a popular and effective invisible graft.
Stated aims: define its role, describe correct technique, provide an application algorithm, and report experience.
The article relates the strut to nasal tip projection and to symmetry of the lower lateral cartilages, with methods for improving each.
The authors state that no previous paper formally defined the strut's singular importance in both primary and secondary open rhinoplasty.
Level of evidence: therapeutic, IV.

What it means for a patient

A small cartilage rod hidden in the column between the nostrils is a standard way to hold the tip at its planned height and to even up the two sides.
The graft usually comes from the patient's own septum and is not visible from outside.
The abstract offers expert guidance without figures on how often the strut is needed or how results compare without it.

Why this paper matters

The Dallas group's algorithm formalized the strut as a routine step in open rhinoplasty. Later work has questioned whether it is needed in every case, particularly compared with the septal extension graft, a debate this paper predates.

Terms

Columellar strut: a cartilage rod placed between the medial crura to support and position the tip.
Columella: the strip of skin and cartilage between the nostrils.
Invisible graft: a graft placed to support structure without showing through the skin.
Tip projection: how far the tip stands out from the face.
Lower lateral cartilages: the paired tip cartilages that shape the tip and nostrils.
Level IV evidence: a case series without a comparison group.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“There are a variety of techniques that can be used to enhance or improve the nasal tip. These techniques often use suture techniques and invisible grafts to achieve the desired result. The former methods have been well described throughout the literature. Among the latter techniques, the columellar strut remains a…”

Excerpt; the full abstract is on PubMed.