This article debates the role of a columellar strut graft through the retrospective aesthetic analysis of 100 consecutive primary open approach rhinoplasties performed by the same single surgeon. The author performs all of these procedures without the use of a columellar graft, tongue-in-groove technique, septocolumellar sutures or columellar / medial crural reinforcement of any kind. Nasal tip support and projection were instead provided by adjustment of anterior septal angle, with septal extension graft when necessary, median suspension suture between the domal area and the middle vault and reconstruction of the scroll attachments. Objective pre and eight to twelve-month postoperative measurements of tip projection and subjective patient satisfaction evaluation were performed and statistical analysis was made comparing pre and postoperative projection, nasolabial angle and Goode ratios. The results showed a consistent improvement of nasal tip parameters in the long-term and a high patient satisfaction with the outcome of the surgery. The authors stress the importance of achieving this without the typical disadvantages of columellar strut grafts, such as an increased rigidity of the nasal tip. This is a very interesting article since it proposes a different philosophy on nasal tip dynamics and support and projection management. The rationale of all this is the reinforcement of natural tip support mechanisms such as ligamentous attachments and a strong caudal border of the quadrangular cartilage instead of an artificial increase of the rigidity of the medial crura by a columellar strut. Nevertheless, the author describes certain situations where this graft could be needed for example patients with tip under projection and a weak nasal base or in cases of columellar deficiencies. Definitively worth reading for any rhinoplasty surgeon.

Revisiting the role of columellar strut graft in primary open approach rhinoplasty.
Bitik O, Uzun H, Kamburoğlu HO, et al.
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Eduardo Morera Serna

Hospital Universitario Son Espases, Palma de Mallorca, Spain.

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