Enhancing nasal tip projection and stability with a columellar strut graft placed in a mucosal flap pocket

Abstract

Objectives: Establishing a stable nasal tip is crucial for both aesthetic and functional outcomes in rhinoplasty. This study aims to present a novel technique used during columellar strut graft placement to enhance tip projection and ensure the stability of the reconstructed nasal tip. Methods: This technique was applied to 22 rhinoplasty patients aged 18 to 52, including 20 primary and two revision cases. The procedure was performed as follows: During tip formation, the mucosal base at the anterior portion of the nasal spine was elevated with a posteriorly based flap while preserving the medial crura connections. This mucosa-crura complex was suspended and sutured to the caudal septum for stabilization and slight projection. A columellar strut graft was placed into a pocket created at the anterior base of the elevated flap to achieve the desired projection, and the tip complex was then reassembled. Results: The columellar strut grafts supported by the mucosal flap were harvested from the septum in 19 patients and from costal cartilage in three patients. The follow-up period ranged from 12 to 24 months. No significant complications were observed in any patient. None required revision due to projection loss, and satisfactory outcomes were achieved. Conclusions: Tip projection and rotation can be better and more reliably controlled with a columellar strut graft supported by a posteriorly based mucosal flap. This easily applicable technique re-duces the long-term risk of projection loss associated with conven-tional columellar strut graft placement. Additionally, it eliminates the need for an extra cartilage graft between the columellar strut and the caudal septum to enhance stability. (c) 2025 The Author(s). Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)