_edited.png)
Response to “Anatomic Columellar Strut, An Alternative Paradigm?”
- 10 hours ago
- 2 min read
Dr. Süleyman Taş responds to questions about anatomic columellar strut grafting, patient selection by skin thickness, Asian rhinoplasty, septal extension grafts and complementary tip-support techniques.
Publication Context
In this Aesthetic Surgery Journal response, Süleyman Taş addresses questions raised after the publication of Concept of Anatomic Columellar Strut Grafting in Rhinoplasty: An Algorithmic Approach. The discussion focuses on how the anatomic strut concept can be applied in Asian patients and how surgeons may choose between a columellar strut and a septal extension graft while seeking long-term stability.
Anatomic Columellar Strut Concept
The anatomic columellar strut concept adds a three-dimensional element designed to correspond more closely to the natural anatomy between the medial crura. The response emphasizes skin thickness as an important factor in patient selection. Thick skin may require a stronger strut that can be constructed from the lower septum; medium-thickness skin can be supported with material obtained from dorsal resection; and thin skin may benefit from a tailor-made strut.
Application in Asian Rhinoplasty
The article notes common anatomic challenges in Asian rhinoplasty, including a thick bulbous tip, short columella, low dorsum, wide base, and broad pyramidal angle. When an anatomic columellar strut is selected, the lower septal portion is described as a useful source. If a septal extension graft is preferred, an anatomic columellar-septal extension graft can be created to combine extension and structural support.
Tip Support Beyond a Single Graft
The response argues against viewing columellar struts and septal extension grafts as the only two mechanisms for tip rotation and support. The lower lateral cartilage framework behaves as a tripod: the medial crura form the central leg while the lateral crura form the two lateral legs. The superior-based transposition (ST) flap can use the lateral legs to influence projection and rotation.
The fix-down technique is also discussed as a way to advance or rotate the septum caudally so that it can function as a natural septal extension graft. If additional support is needed, the response mentions adjunctive techniques including deep SMAS sutures, tongue-in-groove sutures, and septocolumellar sutures.
Individualized Surgical Planning
A recurring principle is that there is no single ideal technique for every nose. Rather than relying on average projection targets, the method should be individualized according to anatomy, skin thickness, available graft material, airway needs, and the desired relationship between support and preservation.
The response summarizes this philosophy as not only preserving nasal structures but also supporting them to obtain durable and natural-looking results.
Official Publication and External Source
Journal: Aesthetic Surgery Journal. Source-derived educational presentation of Dr. Süleyman Taş’s scientific publication; not individualized medical advice.
Comments