In tip rhinoplasty, it has come to my attention that there is a debate among rhinoplasty surgeons. The debate is about what structures provide tip support when performing a tip rhinoplasty. There is no doubt that central support of the tip with a columellar strut is key. However, it is the belief of this surgeon that LATERAL support is also key.Balance in the tip support is not only what makes the shape, but it is what preserves the positioning of the tip over time.
This example of the support of the tip managed in rhinoplasty. It shows how the central support and the lateral positioning of the cartilage grafts help straighten the nostrils and provide support. Not all patients require this approach. However, in secondary rhinoplasty, the tip rhinoplasty can make the difference in managing the balance between the tip and the dorsum.
Lateral Crural Strut Grafts
Lateral crural strut grafts can be fashioned from any type of cartilage, but the strongest cartilage for this purpose is rib cartilage. The second choice would be septal cartilage and lastly, would be ear cartilage. All of these types of cartilage can be used for lateral support, but I find that rib and septum are the best. When performing a tip rhinoplasty alone, the type of support is key. I do not recommend using ear cartilage for lateral crural strut grafts in secondary rhinoplasty.
The lateral crural strut grafts do not necessarily be used with mobilization of the lateral crura. However, it is fairly common to mobilize the lateral crura to do this. The important point in tip rhinoplasty is to fix the lateral crura in position if they are mobilized from their native position.
For more examples of tip rhinoplasty and secondary rhinoplasty, please see the secondary rhinoplasty gallery located here.
Always feel free to call the office at 310-777-8800 or make an appointment to see Dr. Jay Calvert for a consultation regarding rhinoplasty.