Double Columellar Strut: Who, When, and How-Clinical Technique and Outcomes

Achieving the desired long-term results in terms of nasal tip projection and rotation is challenging in rhinoplasty. To improve upon the stability and strength of tip support compared with conventional single-strut grafts, the Double Columellar Strut Graft (DCSG) technique was devised. We reviewed DCSG and assessed its effectiveness, safety, and outcomes in primary and revision rhinoplasty.

This retrospective study examined the outcomes of 42 patients who underwent DCSG-assisted open rhinoplasty between 2020 and 2023. Of these patients, 27 were primary cases, and 15 were revision cases. The Goode ratio, the columellar-labial angle, the NOSE scores, and scores from independent photography evaluations were used to compare pre- and postoperative results. On average, patients were followed up for 18 months.

Following surgery, there was an increase in tip projection (Goode ratio) and columellar-labial angle (median: 85.0 °-96.0 °) in all patients, including those undergoing primary and revision rhinoplasty ( P <0.05). After surgery, NOSE scores declined compared with preoperative values (22.0 versus 13.0) ( P <0.05). Results of independent photographic evaluation also improved after surgery, increasing from 4.0 before to 8.0 after ( P <0.05). In our comparison of the 2 groups, we found that the primary rhinoplasty group had significantly higher tip projection ratios than the revision rhinoplasty group at both the preoperative and postoperative periods ( P <0.05). Graft visibility, extrusions, or infections were not detected.

Consistent, repeatable outcomes with few side effects are possible with the DCSG. Particularly useful for revision and thick-skin rhinoplasty, its mechanical strengthening of the medial crura improves projection control and visual consistency.