The Effect of the Short and Floating Columellar Strut Graft and Septocolumellar Suture on Nasal Tip Projection and Rotation in Primary Open Approach Rhinoplasty

Overview

Surgeons commonly add a small cartilage strut between the nostrils to hold the tip in position. This study tested whether that strut adds anything when two stitches anchoring the tip to the septum are already used. Tip position was measured on standardized profile photographs before surgery, at 1 month, and at 1 year.

Sections of note

• 44 primary open approach rhinoplasty patients, divided into two groups of 22.
• Group 1, suture group: basic tip maneuvers plus two septocolumellar sutures.
• Group 2, suture plus graft group: the same, with a columellar strut graft added for tip support.
• Standardized right profile images taken preoperatively, at 1 month, and at 1 year.
• Projection measured by Goode's method; rotation measured as the nasolabial angle; significance set at p below 0.05.
• Loss of projection from 1 month to 1 year was 3.8% in Group 1 and 3.5% in Group 2, p 0.942.
• Loss of rotation was 4.6 degrees, or 4.1%, in Group 1 and 4.6 degrees, or 4.0%, in Group 2, p 0.979. Level of evidence III.

What it means for a patient

• The tip settled slightly in both groups over the first year, by under 5 percent either way.
• A short strut that is not fixed to the nasal spine did not measurably improve stability here.
• The authors conclude two septocolumellar sutures with basic tip maneuvers are sufficient in most primary cases.
• Limits: 44 patients total, one surgeon, 1 year of follow-up, photographic measurement only, and the finding applies to a short floating strut rather than a fixed one.

Why this paper matters

The columellar strut is one of the most widely used tip support grafts, and this tests a common version against a simpler suture alternative. Longer follow-up and larger numbers would be needed to rule out a smaller real difference.

Terms

• Columellar strut graft: A cartilage piece placed between the nostrils to support the tip.
• Floating strut: A strut not anchored to the bone at the base of the nose.
• Septocolumellar suture: A stitch fixing the tip cartilages to the front edge of the septum.
• Tip projection: How far the tip stands out from the face.
• Nasolabial angle: The angle between the base of the nose and the upper lip, used to gauge rotation.