The effect of the columellar strut graft on nasal tip position in primary rhinoplasty

Rohrich RJ, Kurkjian TJ, Hoxworth RE, Stephan PJ, Mojallal A.

What this paper says

In 100 consecutive primary rhinoplasties measured at one year or more, tip projection fell in 65% of patients and rose in only 27% despite a columellar strut in every case, showing the strut controls tip position rather than pushing the tip out.

Overview

Surgeons have long assumed that a columellar strut, a cartilage rod between the tip cartilages, makes the tip project further. The authors measured the actual change in tip position on photographs of 100 consecutive patients from the senior author (R.J.R.), all of whom had a strut, to test that assumption.

Sections of note

Retrospective review of 100 consecutive primary rhinoplasty patients; postoperative photographs at 1 year or later.
Software compared nasofrontal angle, nasolabial angle, tip projection (x axis) and tip translation (y axis).
Tip projection: decreased 65%, increased 27%, unchanged 8%.
Tip translation: decreased 59%, increased 34%, unchanged 7%.
Nasofrontal angle: increased 67%, decreased 23%, unchanged 10%.
Nasolabial angle: increased 46%, decreased 34%, unchanged 20%.
The abstract does not report the size of the changes in millimeters or degrees.

What it means for a patient

Having a strut placed does not mean your tip will stick out more; in most of these patients it ended up slightly less projected.
The strut's job is to stabilize the two tip cartilages and hold the tip where the surgeon set it.
One surgeon's cases, no comparison group without a strut, and other maneuvers in the same operations also moved the tip.

Why this paper matters

It corrects a widespread assumption and reframes the strut as a stabilizer. Later debate compares the strut with the septal extension graft, which does set projection; this paper does not address that comparison.

Terms

Columellar strut: a cartilage rod placed between the medial crura to support and stabilize the tip.
Tip projection: how far the tip stands out from the face, measured here on the horizontal axis.
Tip translation: the tip's vertical position, up or down.
Nasofrontal angle: the angle between the forehead and the bridge at the root of the nose.
Nasolabial angle: the angle between the columella and the upper lip, a measure of tip rotation.
Primary rhinoplasty: a first-time nose operation.

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

From the abstract

“The columellar strut cartilage graft has historically been assumed to be a technique that increases tip projection. The purpose of this study was to retrospectively analyze a series of 100 consecutive rhinoplasty cases by the senior author (R.J.R.) with a specific focus directed toward the effect of the columellar…”

Excerpt; the full abstract is on PubMed.