Video 4.9: Anatomic Columellar Strut – A Trapezoid Strut That Respects the Medial Crura

What this video shows

A classic columellar strut is a flat slat of septal cartilage; the book explains that it distorts the divergence angle of the middle crura and causes a non-aesthetic, 'operated' appearance. Video 4.9 shows the anatomic strut, which is shaped to fit the trapezoid gap between the medial crura. Its three features are a columellar break point where it meets the columellar defining point, horizontal arms forming a 30–40 degree opening between the medial crura, and an angle between the main body and the arms equal to the divergence angle of the medial and middle crura.

The concept was published by the author in Aesthetic Surgery Journal as 'Concept of Anatomic Columellar Strut Grafting in Rhinoplasty: An Algorithmic Approach', and the book describes three ways of forming the strut, including the keystone anatomic strut obtained from the hump.

Key points

• Trapezoid strut instead of a flat slat.

• Horizontal arms create a 30–40 degree opening between the medial crura.

• Preserves the natural divergence angle and columellar break point.

In the book: Chapter 4 – Nasal Tip Surgery, section 4.3.5 Anatomic Strut Concept, pp. 92–94 of Rhinoplasty in Practice: An Algorithmic Approach to Modern Surgical Techniques (CRC Press, 2021). About the book and all companion videos.

Related publication record: Concept of Anatomic Columellar Strut Grafting in Rhinoplasty: An Algorithmic Approach.

Surgeon: Prof. Dr. Suleyman Tas, plastic, reconstructive and aesthetic surgeon, Istanbul. This video is part of the surgeon-training material of the book; patients considering rhinoplasty in Istanbul can use it to understand the techniques used at Prof. Dr. Suleyman Tas Clinic.