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Double Columellar Strut: A New Method for Tip Surgery—A Study of 642 Cases with a 15-Year Follow-up

  • Original Article
  • Rhinoplasty
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Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Goal

Of the first nasal tip modeling procedures performed, the Anderson tripod concept is the most well known, and many anatomy-related studies have analyzed the components involved in tip surgery. The main goals of nasal tip surgery are to stabilize the tip complex, which largely affects the shape, projection and rotation of the nasal tip.

Objective

The present study describes a new, original method, the double columellar strut and its main advantages compared to conventional techniques used for structural rhinoplasty.

Methods

The study involved 642 patients (496 women and 146 men, with an average age of 38.67 years) who underwent surgery between 2004 and 2018 by two operators. The patients were re-examined to evaluate the outcomes at least 1 year after surgery, and long-term results (15 years) were recorded for the oldest patients in regard to esthetics (projection, shape, rotation) and breathing function.

Results

Of the 642 patients, 34 required a surgical revision for minor defects of the tip due to asymmetry, and the natural appearance after the first surgery was not affected. For the primary rhinoplasties, there were no breathing disorders that required revision surgery due to systematic restoration or preservation of the middle third.

Conclusion

The double columellar strut could be performed in the same conditions that the others conventional structural grafts. As a polyvalent alternative, it can be used with closed or open approaches and involves the use of only a limited amount of cartilaginous material. This anatomical approach yields natural results, acting as a foundation for controlling the shape, projection and rotation of the nasal tip. In addition, with or without complementary techniques such as the “tongue-in-groove” technique or tip grafts, the double columellar strut can be considered a “multifunction pocket knife” for tip surgery.

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.

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References

  1. Janeke JB, Wright WK (1971) Studies on the support of the nasal tip. Arch Otolaryngol Head Neck Surg 93:458–464

    Article  CAS  Google Scholar 

  2. Anderson JR (1984) A reasoned approach to nasal base surgery. Arch Otolaryngol 110:349–358

    Article  CAS  PubMed  Google Scholar 

  3. Tardy ME Jr, Brown RJ (1990) The cartilaginous skeleton. In: Tardy ME Jr, Brown RJ (eds) Surgical anatomy of the nose. Raven Press, New York, p 91

    Google Scholar 

  4. Daniel RK, Palhazi P (2018) The nasal ligaments and tip support in rhinoplasty: an anatomical study Aesthet Surg J 38(4):357–368

    PubMed  Google Scholar 

  5. Pitanguy I, Salgado F, Radwanski HN, Bushkin SC (1995) The surgical importance of the dermocartilaginous ligament of the nose. Plast Reconstr Surg 95(5):790–794

    Article  CAS  PubMed  Google Scholar 

  6. Pitanguy I (1965) Surgical importance of a dermocartilaginous ligament in bulbous noses. Plast Reconstr Surg 36:247–253

    Article  CAS  PubMed  Google Scholar 

  7. Han SK, Lee DG (2004) An anatomic study of nasal tip supporting structures. Ann Plast Surg 52(2):134–139

    Article  PubMed  Google Scholar 

  8. Adams WP Jr et al (1999) Anatomic basis and clinical implications for nasal tip support in open versus closed rhinoplasty. Plast Reconstr Surg 103(1): 255–261 (discussion: 262–264)

  9. Beaty MM, Dyer WK II, Shaw MW (2002) The quantification of surgical changes in nasal tip supports. Arch Facial Plast Surg 4(2):82–91

    Article  PubMed  Google Scholar 

  10. Gassner HG, Remington WJ, Sherris DA (2001) Quantitative study of nasal tip support and the effect of reconstructive rhinoplasty. Arch Facial Plast Surg 3(3):178–184

    Article  CAS  PubMed  Google Scholar 

  11. Westreich RW, Lawson W (2007) The tripod theory revisited: the cantilevered spring model. Arch Facial Plast Surg 9:264–270

    Article  PubMed  Google Scholar 

  12. Saban Y, Polselli R (2015) Architecture ostéocartilagineuse du nez. In: Saban Y, Polselli R (eds) Anatomie de la face et du cou en chirurgie et cosmétologie. Elsevier Masson, Paris, pp 263–266

    Google Scholar 

  13. Saban Y, Polselli R, Mejanelle L (2002) Rhinoplasties. Morphodynamic anatomy of the nose. Amplifon Monographs 1:25–32

    Google Scholar 

  14. Saban Y, Amodeo CA, Hammou JC (2008) An anatomical study of the superficial musculoaponeurotic system: surgical applications in rhinoplasty. Arch Facial Plast Surg 10:109–115

    Article  PubMed  Google Scholar 

  15. Johnson CM Jr, Toriumi DM (1990) Restructuring the lower third of the nose. Johnson CM Jr. Toriumi DM Open Rhinoplasty Structure, Saunders, pp 123–161

    Google Scholar 

  16. Tebbetts JB (1994) Nasal sha** and positionning the tip without structural disruption: new systematic approach. Plast Reconstr Surg 94:61–77

    Article  CAS  PubMed  Google Scholar 

  17. Toriumi DM (2000) Structure concept in nasal tip surgery. Op Tech Otolaryngol Head Neck Surg 7:175–186

    Google Scholar 

  18. Kosins AM, Lambros V, Daniel RK (2015) The plunging tip: analysis and surgical treatment. Aesthet Surg J 35(4):367–377

    Article  PubMed  Google Scholar 

  19. Kosins AM, Lambros V, Daniel RK (2014) The plunging tip: illusion and reality. Aesthet Surg J 34(1):45–55

    Article  PubMed  Google Scholar 

  20. Jallut Y (2015) The plunging or droopy tip, fantasy or reality? In: National 28th SOFCEP Congress Nice, June 4th–6th

  21. Powell NR, Humphreys B (1984) Proportions of the aesthetic face. Thieme- Stratton Inc, New York

    Google Scholar 

  22. Armijo BS, Brown M, Guyuron B (2012) Defining the ideal nasolabial angle. Plast Reconstr Surg 129:759–764

    Article  CAS  PubMed  Google Scholar 

  23. Gunter JP, Rohrich RJ, Friedman B (1996) Classification and correction of alar- columellar discrepancies in rhinoplasty. Plast Reconstr Surg 97(3):643–648

    Article  CAS  PubMed  Google Scholar 

  24. Rohrich RJ, Liu JH (2012) Defining the infratip lobule in rhinoplasty: anatomy, pathogenesis of abnormalities and correction using an algorythm approach. Plast Reconstr Surg 130(5):1148–1158

    Article  CAS  PubMed  Google Scholar 

  25. Sheen JH (1978) Aesthetic rhinoplasty, 1st edn. Mosby, St Louis

    Google Scholar 

  26. Toriumi DM (2006) New concepts in nasal tip contouring. Arch Facial Plast Surg 8:156–185

    Article  PubMed  Google Scholar 

  27. Toriumi DM, Checcone MA (2009) New concepts in nasal tip contouring. Facial Plast Surg Clin North Am 17:55–90

    Article  PubMed  Google Scholar 

  28. Cakir B, Oreroglu AR, Daniel RK (2014) Surfaces aesthetics in tip rhinoplasty: a step- by-step guide. Aesthet Surg J 34(6):941–955

    Article  PubMed  Google Scholar 

  29. Manuel CT et al (2014) Nasal tip support: a finite element analysis of the role of the caudal septum during tip depression. Laryngoscope 124(3):649–654

    Article  PubMed  Google Scholar 

  30. Anderson JR (1966) A new approach to rhinoplasty. Trans Amer Ophtal Otolaryng 70:183–192

    CAS  Google Scholar 

  31. Tardy ME Jr, Patt BS, Walter MA (1993) Transdomal suture for a refinement of the nasal tip. Facial Plast Surg 9:275–284

    Article  PubMed  Google Scholar 

  32. Jallut Y (2014) Correction of the broad nasal tip. Ann Chir Plast Esthet 59(6):467–480

    Article  CAS  PubMed  Google Scholar 

  33. Calvert J, Kwon E (2015) Technique for diced cartilage with deep temporalis fascia graft. Facial Plast Surg Clin North Am 23(1):73–80

    Article  PubMed  Google Scholar 

  34. Daniel RK (2011) Rhinoplasty: open-tip suture techniques: a 25-year experience. Facial Plast Surg 27(2):213–224

    Article  CAS  PubMed  Google Scholar 

  35. Dosanjh AS, Hsu C, Gruber RP (2010) The hemitransdomal suture for narrowing the tip. Ann Plast Surg 64(6):708–712

    Article  CAS  PubMed  Google Scholar 

  36. Guyuron B, Behmand RA (2010) Nasal tip sutures; part II: the interplays. Plast Reconstr Surg 112(4):1130–1145

    Article  Google Scholar 

  37. Rohrich RJ et al (2012) The effect of the columellar strut graft on nasal tip position in primary rhinoplasty. Plast Reconstr Surg 130(4):926–932

    Article  CAS  PubMed  Google Scholar 

  38. Peck GC (1983) The onlay graft for nasal tip projection. Plast Reconstr Surg 71:27–39

    Article  CAS  PubMed  Google Scholar 

  39. Davis RE (2015) Lateral crural tensioning for refinement of the wide and underprojected nasal tip: rethinking the lateral crural steal. Facial Plast Surg Covering joint North Am 23(1):23–53

    Article  Google Scholar 

  40. Kovacevic M, Wurm J (2015) Spreader flaps for middle vault contour and stabilization. Facial Plast Surg Clin North Am 23(1):1–9

    Article  PubMed  Google Scholar 

  41. Constantian MB, Clardy RB (1996) The relative importance of nasal valvular surgery in correcting airway obstruction in primary and secondary rhinoplasty. Plast Reconstr Surg 98(1):38–53

    Article  CAS  PubMed  Google Scholar 

  42. Nardi Korner Vian H, Sarraff Berger CA, Candia Barra D, Perin AP (2018) Revision rhinoplasty: physician-patient aesthetic and functional evaluation. Braz J Otolaryngol 84(6):736–743

    Google Scholar 

  43. Loghmani S, Loghmani A, Maraki F (2019) Secondary rhinoplasty: Aesthetic and functional concerns. Plast Reconstr Surg 27(3):217–222

    Google Scholar 

  44. Crosara Borges PFT, Barbosa Nunes F, Santana Rodrigues D, Pimentel Figueiredo AR, Gonçalves Becker HM, Gonçalves Becker C, Santos Guimaraes RE (2017) Rhinoplasty complications and reoperations: systematic review. Int Arch Otolaryngol 21:97–101

    Google Scholar 

  45. East C, Kwame I, Hannan SA (2016) Revision rhinoplasty: what can we learn from error patterns? An analysis of revision surgery. Facial Plast Surg 32:409–415

    Article  CAS  PubMed  Google Scholar 

  46. Rohrich RJ, Durand PD, Dayan E (2020) Changing role of septal extension versus columellar grafts in modern rhinoplasty. Plast Reconstr Surg 145(5):927e–931e

    Article  CAS  PubMed  Google Scholar 

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Acknowledgement

Special thanks to Dr. Bianca Knoll and Dr. Jay Calvert for their help.

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Authors and Affiliations

  1. Immeuble Convergence, 50 rue Berthy Albrecht, 84000, Avignon, France

    Yves Jallut & Caroline Bartolin

Authors
  1. Yves Jallut
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  2. Caroline Bartolin
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Corresponding author

Correspondence to Yves Jallut.

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Appendix

Appendix

  • figure a

    Result 1: Primary rhinoplasty, results at 2 years postoperatively.

  • figure b

    Result 2: Primary rhinoplasty, results at 1 year postoperatively.

  • figure c

    Result 3: Secondary rhinoplasty, results at 2 years postoperatively.

  • figure d

    Result 4: Primary rhinoplasty, results at 1 year postoperatively.

  • figure e

    Result 5: Primary rhinoplasty, results at 1 year postoperatively.

  • figure f

    Result 6: Primary rhinoplasty, results at 1 year postoperatively.

  • figure g

    Result 7: Postraumatic rhinoplasty, results at 15 years postoperatively.

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Jallut, Y., Bartolin, C. Double Columellar Strut: A New Method for Tip Surgery—A Study of 642 Cases with a 15-Year Follow-up. Aesth Plast Surg 45, 229–241 (2021). https://doi.org/10.1007/s00266-020-01934-5

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  • DOI: https://doi.org/10.1007/s00266-020-01934-5

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