The dorsal columellar strut: Innovative use of dorsal hump removal for a columellar strut

Abstract

Background: Dorsal hump reduction is a common complaint among primary cosmetic rhinoplasty patients. Newer techniques for addressing the dorsal hump focus on the preservation, reinforcement, or modification of existing structures. Objectives: The authors describe their technique of a "dorsal columellar strut," an innovative use of dorsal nasal cartilage from hump removal for a columellar strut. Combined with other cartilage-conserving techniques, this forgoes the morbidity and operative time of a septal cartilage harvest while preserving-and possibly increasing-tip support. Methods: Candidates for this procedure are selected based on a number of criteria. Ideally, the patient is one who requires 3 mm or more of dorsal hump reduction with tip reshaping and refinement. Each patient is treated using the open technique with a stair-step columellar incision, combined with an infracartilaginous incision. Results: With the addition of the authors cartilage-conserving techniques (autospreader flap, lower lateral turnover, and tip suturing), patients experience successful reshaping of the middle vault and nasal tip. Conclusions: In well-selected patients, the authors have found their technique to be efficient, effective, and aesthetic. The precise dorsal reduction allows surgeons to use the cartilage fragment as a dorsal columellar strut, foregoing the standard septal harvest and reducing operative time and patient morbidity. © 2010 The American Society for Aesthetic Plastic Surgery, Inc.