Invited Discussion on: Comma-Shaped Columella Strut for Nasal Tip Plasty in East Asian Rhinoplasty
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EDITOR’S INVITED COMMENTARY
Invited Discussion on: Comma-Shaped Columella Strut for Nasal Tip Plasty in East Asian Rhinoplasty Chin-Ho Wong1
Received: 21 August 2020 / Accepted: 22 August 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020
Level of Evidence V 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. I enjoyed reading this article [1]. The authors are to be congratulated on developing and reporting their clinical experience with the use of their technique. They stressed the importance of solid support for the nasal tip to overcome the significant postoperative contracture and scarring in the nasal soft tissues that tend to retract and weaken the integrity of the cartilaginous framework in Asian rhinoplasty. Their solution to this is a very rigid comma-shaped columella strut with a 3-point fixation which they have beautifully illustrated in Fig. 2 of their article. This approach highlights one key concept in Asian rhinoplasty: Strong projection into the thick soft tissue envelop is key to effectively getting the soft tissue envelop to conform to the desired framework and ultimately to achieving good longlasting results. An interesting remark by the authors as I quote, ‘certain methods that might achieve dramatic aesthetic outcomes in Caucasian or Persian noses might not be entirely applicable to the East Asian Population.’ This profound remark crystallizes the challenges and frustration of surgeons performing Asian rhinoplasty when attempting to apply
& Chin-Ho Wong [email protected] 1
W Aesthetic Plastic Surgery, #06 – 28/29, Mount Elizabeth Novena Specialist Center, 38 Irrawaddy Road, Singapore 329563, Singapore
techniques described in Caucasian rhinoplasty to our patients. This is relevant not only in the selection of technique to be used but also application of the techniques selected because modification will be needed for the Asian nose. In selecting an appropriate technique, the thicker skin and weaker cartilages in the Asian nose, more aggressive techniques are generally needed to predictably achieve the desired modification. Regarding the latter (application of a specific technique), when executing these techniques, modifications of the classic description in the Caucasian literature may be necessary to maximally harness its potential for its use in Asian nose. These two points may be appreciated with the selection of the appropriate tip support with some forms of columella strut for Asian patients, the central topic of this article. There are two basic forms of columella strut, the floating strut and the fixed strut. The floating strut is the most commonly used technique in Caucasian rhinoplasty and is a go-to maneuver to maintain tip support and projection [2]. The floating columella strut, however, is the less powerful
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