Columellar Strut Placement During Ethnic Rhinoplasty

(the following is a transcript of the above video)

Our next step is to carve the cartilage so we can use this for grafting. I’m carving what we call a columellar strut. This is something that we’re gonna put in between the cartilage. To help lift it.

You will notice, I’m very delicate, very careful and very meticulous when I carve this because this cartilage is not very thick. I want to make sure that I don’t make it too thin. We can’t have it too thick. We can’t have it too thin.

Carving a columellar strut from harvested rib cartilage.

This is our columellar strut. I’ll show you where we’ll place that in a minute. We might have to use this to make something called a shield graft. That will give the tip more projection and definition.

Now we’re going to insert the piece of cartilage in the little pocket here and then we’re going to stitch everything together. We’re placing little sutures.

Placing the custom-carved columellar strut into position and delicately suturing it into place.

We’re gently, carefully and symmetrically suturing this piece of cartilage to the existing cartilage called medial crura.

We’re trying to elevate the current cartilage to a higher level or what we call more projection and this is a very important part of this rhinoplasty. I have to make sure that everything is very symmetric.

Now we’re stitching the medial crura cartilage to the columellar strut. We’re advancing this cartilage, the natural cartilage onto this strut to give it more projection. If we tent it up, just like putting a pole in the middle of a round tent and lifting it up, it will appear more narrow. That’s our goal.

This is the foundation for this rhinoplasty. This one piece of cartilage. Obviously, there’ll be a lot more, but this is what we need to really focus on.
That it’s nice and symmetric.

Checking the nose to ensure symmetry.

It’s very difficult to make this part of the surgery absolutely symmetric, but our goal is really to do the best we can. What we’re trying to do is just make everything look good you know, symmetry is what this is all about.

You have to do it right the first time. If you don’t like it, you go back and do it again. Already I’m seeing some increased projection of the nose. The tip is already appearing slightly smaller. I really like that. That’s a good base for us to start with.