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

BACKGROUND: 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 strut on final tip position, namely, tip projection and tip rotation.
METHODS: Medical information and digital images were obtained from 100 consecutive primary rhinoplasty patients. All postoperative images were obtained from 1-year or greater follow-up visits. Preoperative and postoperative digital images were compared using a software application that quantitatively analyzed various facial anatomical features, including the nasofrontal angle, the nasolabial angle, tip projection, and tip translation.
RESULTS: Tip projection (defined as the tip position on the x axis) actually decreased in 65 percent, increased in 27 percent, and was unchanged in 8 percent of subjects. Tip translation (defined as the tip position on the y axis) was decreased in 59 percent, increased in 34 percent, and unchanged in 7 percent. The nasofrontal angle was increased in 67 percent, decreased in 23 percent, and unchanged in 10 percent of patients. The nasolabial angle was increased in 46 percent, decreased in 34 percent, and unchanged in 20 percent.
CONCLUSION: Use of the columellar strut cartilage graft does not necessarily imply an increase in tip projection, but rather serves as a means of unifying the nasal tip and helping to control final tip position.