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Original Article |

Measured Gain in Projection With the Extended Columellar Strut-Tip Graft in Endonasal Rhinoplasty

Michael A. Carron, MD; Richard A. Zoumalan, MD; Norman J. Pastorek, MD
JAMA Facial Plast Surg. 2013;15(3):187-191. doi:10.1001/jamafacial.2013.718.
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Importance The extended columellar strut-tip graft was designed to improve nasal tip projection and tip definition in patients undergoing rhinoplasty.

Objective To determine whether the extended columellar tip graft leads to a true and measurable increase in nasal tip projection or simply gives the illusion of an increase in projection.

Design Retrospective case review. The mean time of follow-up photographs was 32 months after surgery (range, 8 months to 10 years).

Participants The study population comprised 15 patients who underwent primary or revision rhinoplasty during the last 10 years.

Intervention Primary or revision rhinoplasty.

Main Outcome Measure The outcome measure was the long-term gain in nasal tip projection. Preoperative and postoperative images were cropped and sized equally for accurate comparison. All measurements were made from the alar-facial crease to the tip defining point.

Results In all 15 patients, an increase in tip projection was obtained. The mean increase in projection was 19% compared with the preoperative projection. After applying a paired t test for analysis, there was a statistically significant increase in nasal projection (P < .05).

Conclusions and Relevance The extended columellar strut-tip graft effectively corrected poor nasal tip projection. The effect is maintained years later. The extended columellar strut-tip graft is an excellent choice in endonasal rhinoplasty to improve poor tip projection and definition.

Level of Evidence 4.

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Figures

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Figure 1. Shape and placement of the extended columellar strut-tip graft (ECSTG). A, Fashioned from septal cartilage, this is the shape of the ECSTG. B, This is the approximate placement area for the ECSTG. C, Endonasal placement of the ECSTG. It is placed in a precise pocket immediately before the end of the case, before the incision is closed.

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Figure 2. Preoperative and postoperative photographs of a patient who underwent placement of an extended columellar strut-tip graft as part of her rhinoplasty. Images A, C, E, G, I, and K are preoperative photographs. Images B, D, F, H, J, and L are postoperative. Postoperative photographs were taken at 2 years after surgery.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 3. Preoperative and postoperative photographs of a patient who underwent placement of an extended columellar strut-tip graft as part of her rhinoplasty. Images A, C, E, G, I, and K are preoperative photographs. Images B, D, F, H, J, and L are postoperative. Postoperative photographs were taken at 1 year after surgery.

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