Comma-Shaped Columellar Strut for Nasal Tip Plasty in East Asian Rhinoplasty

You J, Wu L, Xu Y, Fan F, Wang H.

PubMed 32914325 Publisher (DOI)Free full text (PMC)

What this paper says

Among 165 women who had augmentation rhinoplasty with a comma shaped cartilage support for the tip, 8 needed minor revision for crooked nostrils and 3 for a warped bridge graft over an average 12 months.

Overview

East Asian rhinoplasty is mostly concerned with building a defined nasal tip. The authors present a graft shaped like a comma that serves as a single integrated piece providing tip support while also setting the angles between tip and columella. The series covers four years of practice.

Sections of note

Case series of 165 female patients, age 18 to 42, average 27.1 years; journal assigned level of evidence IV.
Average postoperative follow up was 12 months.
Seventy eight cases were primary; the remainder were secondary or later operations.
The framework was rebuilt around the comma strut together with spreader grafts and dorsal onlay grafts.
Patients rated overall improvement themselves, described as a high satisfaction rate with no figures given.
Eight cases had asymmetric nostrils with a slightly deviated columella and had minor revision surgery.
Three cases had warping of the dorsal graft and were corrected.
No other major complications were reported.

What it means for a patient

Eleven of 165 patients, about 7 percent, needed a further procedure within the follow up period.
The graft is a structural support placed inside the nose to hold the tip in position.
Satisfaction was self reported without a validated questionnaire and no comparison group was used.
Twelve months average follow up is short for detecting late cartilage warping.

Why this paper matters

Tip support is the durability problem in augmentation rhinoplasty, and strut design determines whether the tip holds its position. This series reports one design across a sizeable number of patients. Whether the comma shape outperforms a straight strut has not been tested directly.

Terms

Columellar strut: a cartilage post placed between the nostrils to support the nasal tip.
Lobular columellar angle: the angle where the rounded tip meets the strip between the nostrils.
Supratip break: the slight dip on the bridge just above the tip.
Spreader graft: a cartilage strip beside the septum that widens the internal breathing valve.
Warping: gradual bending of a cartilage graft after surgery.

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

Abstract

Background: For East Asians, rhinoplasty procedures are predominantly focused on reconstructing a well-defined nasal tip. In this study, the authors present a new graft design for the columellar strut that is similar to the shape of a comma mark. As one integrated piece, the graft undertakes the roles of providing solid support for the tip, modifying different angles, as well as relationships between the tip and columella.

Methods: One hundred and sixty-five female patients, ranging in age from 18 to 42 years (average 27.1 years), received augmentation rhinoplasty surgery over the past 4 years with an average postoperative follow-up of 12 months. Among these patients, 78 of them were primary cases and others were secondary or more. The cartilaginous framework was reconstructed based on comma strut with other grafts including spreaders and dorsal onlay grafts.

Results: Patients' own evaluations on the overall improvements of the nose rendered high satisfaction rate. During the long-term follow-up, 8 cases presented asymmetrical nostrils with slightly deviated columella; minor revision surgeries were performed. Another 3 cases presented dorsal graft warping and were also corrected. No other major complications were encountered.

Conclusions: The comma strut provides a reliable support for the nasal tip; its dual curved structure plays the instrumental role in defining the lobular-columellar angle as well as modifying the supratip break. This graft design offers good control of tip and columella; as a result, consistent, reproducible results can be achieved.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).