How does the Strut technique change the nose tip? The role of the support pillar and the difference from septal extension

The Strut technique is a method of inserting a cartilage support pillar into the columella (the pillar between the nostrils) to support the nose tip from below[1]. It is used for nose tips with a short columella or recessed under-nose area, and can project the nose tip forward or lengthen the columella[1]. However, some reports indicate that a support pillar alone makes it difficult to maintain nose tip height over time, and whether to combine it with septal extension becomes a key decision point[2][3].

How does the Strut technique change the nose tip?

Inserting a support pillar can be expected to produce changes such as the nose tip projecting forward, the columella lengthening, the upper edge of the nostril rising, and the angle under the nose widening[1]. It is used as one technique to stabilize the foundation before refining the nose tip shape[4].

The shape of the support pillar and the type of cartilage used vary depending on the desired shape, the amount of available cartilage, and the surgical approach[4].

What nose tip shape is it suited for?

It is well-suited for nose tips with a short columella, recessed under-nose area, or sharp angle beneath the nose[1]. A nose tip with weak support that easily caves in when pushed with a finger is also a candidate[1].

In such cases, simply layering cartilage on top makes it difficult to maintain height over time, so a support pillar is considered necessary[1].

What should be kept in mind for Asian noses?

Asian noses are reported to frequently have characteristics such as a short columella, thick skin, and a rounded nose tip[5]. The septal cartilage available for surgery is also known to be smaller compared to Caucasians[5].

When cartilage is soft and small and the skin is thick, a support pillar or septal extension alone may make it difficult to elevate and maintain the nose tip height[6]. When using ear cartilage, if the surrounding membrane is not harvested together, support is insufficient, and postoperative complications such as columella deviation or nose tip drooping can occur[6].

What is the difference compared to septal extension?

Many reports indicate that septal extension is superior in the ability to lengthen and stabilize the nose tip[3]. A review based on a study following 87 patients for up to 4 years concluded that the support pillar is not essential for elevating the nose tip and should be selected according to the surgical goal[3].

Another study found that nose tip height initially increased with both methods postoperatively and then slightly decreased, with no clear difference[7]. In contrast, nose tip projection was more pronounced with the support pillar initially pointing upward, then regressing significantly[7].

It has been noted that if the support pillar is not secured to the edge of the septum or placed against a bony foundation, it is difficult to maintain nose tip height as desired[8]. For this reason, some surgeons add a small support pillar as an auxiliary technique to septal extension[9].

What are the risks?

Specialized texts on nasal structure point out that after using a support pillar, changes such as loss of nose tip support or height and a downward-pointing nose tip commonly occur[2]. The primary cause is insufficient support of the nasal foundation[2].

In patients with thin skin and weak cartilage, problems such as alar retraction, asymmetry of the nose tip, visibility of transplanted cartilage, and reduced nasal airflow are more likely to occur[2]. A rigid support pillar that maintains long-term fixation can project the nose tip strongly but results in a stiffened nose tip[1].

What should be confirmed during consultation?

Whether to use the Strut technique alone or combine it with septal extension depends on the nasal foundation[4][3]. During consultation, have the strength of nose tip support, skin thickness, and amount of available cartilage examined.

Then, confirm with your surgeon whether a support pillar alone is sufficient, whether septal extension is necessary, and how much nose tip stiffness you can tolerate, so you will have fewer doubts later.