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>> Dr. Lamperti: This is Seattle facial plastic surgeon, Dr. Thomas Lamperti. Today I'm going
to show you how to place a columellar strut in order to maintain tip support during rhinoplasty.
First we have to carve the columellar strut. Here I'm carving the strut from a portion
of septal cartilage that I harvested from the patient earlier in the procedure. In this
patient I'm looking to create a straight columellar strut. In patients with tip deviation I'll
sometime use a curved piece of cartilage to create the strut in order to push the tip
in the direction I want.
Once I'm happy with the strut dimensions I dissect a pocket between the medial crura
of the nasal tip. I dissect down to the very base of the nose in order to create the most
support once the strut is placed.
Next I'll insert the columellar strut in this newly formed pocket. As you can see I make
the pocket fairly precisely sized so that the graft doesn't have anyway to migrate to.
Once the graft is in place I fine tune its length using a scalpel. We want to make sure
that there won't be a cartilage edge that is going to press up against the nasal tip
skin.
Ultimately, I'll then secure the graft in place using a dissolving suture that is placed
in a quilting fashion that loops through both sides of the columella. We place a columellar
strut during rhinoplasty in order to maintain tip support and prevent tip drooping as the
nose heals.
www.drlamperti.com