Comma-Shaped Columellar Strut for Nasal Tip Plasty in East Asian Rhinoplasty
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ORIGINAL ARTICLE
RHINOPLASTY
Comma-Shaped Columellar Strut for Nasal Tip Plasty in East Asian Rhinoplasty Jianjun You1 • Lehao Wu1 • Yihao Xu1 • Fei Fan1 • Huan Wang1
Received: 5 June 2020 / Accepted: 16 August 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020
Abstract Background For East Asians, rhinoplasty procedures are predominantly focused on reconstructing a well-defined nasal tip. In this study, the authors present a new graft design for the columellar strut that is similar to the shape of a comma mark. As one integrated piece, the graft undertakes the roles of providing solid support for the tip, modifying different angles, as well as relationships between the tip and columella. Methods One hundred and sixty-five female patients, ranging in age from 18 to 42 years (average 27.1 years), received augmentation rhinoplasty surgery over the past 4 years with an average postoperative follow-up of 12 months. Among these patients, 78 of them were primary cases and others were secondary or more. The cartilaginous framework was reconstructed based on comma strut with other grafts including spreaders and dorsal onlay grafts. Results Patients’ own evaluations on the overall improvements of the nose rendered high satisfaction rate. During the long-term follow-up, 8 cases presented asymmetrical nostrils with slightly deviated columella; minor revision surgeries were performed. Another 3 cases presented dorsal graft warping and were also corrected. No other major complications were encountered. Conclusions The comma strut provides a reliable support for the nasal tip; its dual curved structure plays the Jianjun You and Lehao Wu contributed equally to this work. & Huan Wang [email protected] 1
Department of Plastic Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Plastic Surgery Hospital and Institute, 33 Badachu Rd., Shijingshan District, Beijing 100144, China
instrumental role in defining the lobular-columellar angle as well as modifying the supratip break. This graft design offers good control of tip and columella; as a result, consistent, reproducible results can be achieved. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Keywords Columellar strut Comma shape Rhinoplasty Rib cartilage
Introduction One prominent feature of a typical East Asian nose is its weak, flat nasal tip [1]. This is due to their inherently thin and weak lower lateral cartilages [2]. Therefore, nasal tip plasty for this group of people requires adequate structural support and transpositions of soft tissue and cartilages to address this deficiency [3]. Structural reconstruction of the nasal vault framework, in particular the columellar strut graft, is consequently an indispensable element in nasal tip plasty [
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