Wide-Based Columellar Strut Graft: A Novel Boost for Enhanced Nasal Tip Support in Ethnic and Revision Rhinoplasty

Abstract

Background: Adequate nasal tip support is crucial for achieving both aesthetic and functional outcomes in rhinoplasty. This study introduces a wide-based columellar strut graft (WB-columellar strut graft) as a new modification to provide enhanced support for the nasal tip, especially in challenging ethnic and revision rhinoplasty cases. Objective: To present and evaluate the effectiveness of the WB-columellar strut graft in providing sufficient nasal tip support and achieving satisfactory aesthetic outcomes in patients with ethnic noses, Asian noses, and revision rhinoplasty cases presenting with weak caudal septum or anterior nasal spine. Materials and Methods: A total of 32 patients, aged between 17 and 48, were included in this study. Of these, 11 were revision cases, 12 had ethnic noses, and nine had Asian noses. The technique involved preparing a WB-columellar strut graft in two different ways according to the need of particular case. WB-columellar strut graft-1: Constructed from either costal or septal cartilage, with a widened columellar base using bilateral grafts and a columellar strut graft. WB-columellar strut graft-2: Exclusively from costal cartilage, featuring a groove on the anterior surface for insertion of a columellar strut graft to form a wide-based structure. The grafts were applied to provide robust support in cases, where the caudal septum and spine were excessively resected. Results: In 25 patients, the graft was prepared from costal cartilage, while in seven patients it was from septal cartilage. The WB-columellar strut graft-1 modification was used in 22 patients, and the WB-columellar strut graft-2 in 10 patients. Follow-up ranged from 12 to 24 months, with only one case requiring a mini-revision due to visible tip graft. No significant complications were reported in other patients. Conclusion: The WB-columellar strut graft is an effective boost for enhancing nasal tip support in ethnic and revision rhinoplasty cases. It provides a more robust structural foundation, leading to long-lasting and satisfactory aesthetic results. This technique is particularly beneficial for patients with retracted caudal septum and weak anterior nasal spine, providing improved nasal tip projection and rotation. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.