Revisiting the role of columellar strut graft in primary open approach rhinoplasty

Overview

A columellar strut is a small piece of cartilage placed between the tip cartilages to support the nasal tip. Whether it actually controls final tip position has been argued for years. The authors reviewed 100 consecutive primary open rhinoplasty cases performed without one, and compared the preoperative photograph, the digitally morphed plan and the actual result.

Sections of note

• Data came from patient charts and digital images of 100 consecutive primary open rhinoplasty patients.
• Preoperative, morphed and actual postoperative images were measured with image-processing software.
• Measures included nasal tip projection, nasolabial angle and the Goode ratio.
• Long-term patient satisfaction was surveyed.
• There was no universal trend toward either more or less tip projection after primary rhinoplasty.
• Planned changes in projection, rotation and profile proportions were achieved with statistically significant accuracy without a strut. Columellar contour irregularity occurred in 3 percent.

What it means for a patient

• A strut graft is not required to hit the agreed plan for tip position, provided the nose's own support structures are kept or rebuilt.
• Comparing the morphed simulation with the actual result is a direct test of whether the planned nose was delivered.
• The 3 percent irregularity rate refers to a visible bump or unevenness in the strip of skin between the nostrils.
• Single practice, retrospective, no group operated with a strut for direct comparison, and the abstract does not state the follow-up period.

Why this paper matters

Tip support philosophy divides rhinoplasty surgeons, with one camp adding structural grafts routinely and another preserving native anatomy. This series argues the second position can meet planned targets. It does not prove a strut is unnecessary in every nose, and noses with weak native support were not separately analysed.

Terms

• Columellar strut graft: a cartilage support placed in the column of skin between the nostrils to hold the tip.
• Primary rhinoplasty: a first operation on a nose that has not been operated on before.
• Open approach: rhinoplasty using a small external incision across the columella to lift the skin.
• Morphed image: a digitally altered photograph used to plan and show the intended result.
• Goode ratio: a photographic measurement of nasal tip projection.
• Nasolabial angle: the angle between the base of the nose and the upper lip.