Columellar strut in rhinoplasty
Reviewed by Felipe Culaciati

Several techniques are described to improve nasal tip shape; most of them include suture techniques or invisible grafts. In this article the author wants to put emphasis in the role of the columellar strut graft as a method to correct tip projection and lateral crura cartilage symmetry. The aim of this study is to review retrospectively a rhinoplasty series from 1986 to 2009 in an attempt to describe the proper role of the columellar strut graft in patients undergoing a rhinoplasty, and to describe how it has to be placed correctly and provide a clinical algorithm for its application. A total of 1734 primary rhinoplasties were performed during this period. Ninety-eight percent of these cases were operated using an open approach, in 86% of them a columellar strut graft was set in position. The reasons it was placed were: 34% to maintain adequated tip projection, 26% were set to solve tip asymmetries, 22% were placed for a combination of tip asymmetry and to maintain tip projection, 12% were placed to address intraoperative loss of tip projection. In the algorithm for the placement of the columellar strut graft the author considers two main variables and four different options for a columellar strut placement. The variables are the strength and symmetry of the lower lateral cartilage (type I–IV) and adequate tip projection. With a combination of these two variables it is recommended to use four different types of columellar strut, which are: no strut, short strut (for tip refinement), long floating strut, long and fixed strut (for tip strength and definition). The author claims a revision rate of 6% in primary rhinoplasty. Despite the vast experience and the good revision rate percentage presented by the author, perhaps an interesting point of this article is the suggested use of a floating strut when we face the situation of weak but symmetric lower lateral cartilage without an adequate tip projection; this point can be questioned by other experienced rhinoplasty surgeons who argue that a well fixed columellar strut to the nasal spine helps to achieve good long-term results in tip projection. 

The role of the columellar strut in rhinoplasty: indications and rationale.
Rohrich RJ, Hoxworth RE, Kurkjian TJ.
PLASTIC AND RECONSTRUCTIVE SURGERY
2012;129:118e-125e.