In the majority of my primary and revision rhinoplasties in males, a columellar strut is placed. This graft sets the foundation for tip projection as the nasal tip is rebuilt. Columellar struts may be carved from septal cartilage (my preference), auricular cartilage or rib
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cartilage. If the patient has had a septoplasty in the past, palpation of the septum may help determine if any significant cartilage remains. In many instances, cartilage is present along the dorsal septum. In addition to the endonasal approach, dorsal septal cartilage may be harvested from the open approach by elevating the middle vault mucoperichondrium from the septum following release of the caudal end of the upper lateral cartilage. Dorsal septum maybe harvested without loss of dorsal support as long as at least one centimeter of septum is preserved. If the septal cartilage harvested is short, two segments may be sutured to one another towards their distal ends.
Video Produced by Spore Medical
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