There are a variety of techniques that can be used to enhance or improve the nasal tip. These techniques often use suture techniques and invisible grafts to achieve the desired result. The former methods have been well described throughout the literature. Among the latter techniques, the columellar strut remains a popular and effective form of an invisible graft in rhinoplasty. The purpose of this article is to define the role of the columellar strut graft, describe how to perform it correctly in rhinoplasty, provide a clinical algorithm for its application, and detail a 15-year retrospective analysis of the senior author's (R.J.R.) experience. Previous references to the importance of the columellar strut graft in rhinoplasty have been described; however, none has formally defined its singular importance in both primary and secondary open rhinoplasty. This article details the role of the columellar strut and its relationship to nasal tip projection and lower lateral cartilage symmetry with an explanation of methods for improving each.
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