I was asked this question today by a patient who I saw in consultation for revision rhinoplasty, after I mentioned that her tip needed support.
Let’s start with the basics. The tip of the nose is made up of two cartilages named alar cartilages. The cartilages have three sections. The medial crus, the dome, and the lateral crus. Think of the tip as made up of a tripod. One leg is composed of the two medial crura of both cartilages put together. This located in the columella of the nose. The two other legs of the tripod are both lateral crura. The dome is the mid-point between the medial and lateral crus and actually make up the nasal tip.
When a nose has weak cartilages, the tip is weak. When a rhinoplasty procedure is performed on a nose with weak cartilages, the tip must be stregnthed. Failure to strengthen the tip will result in tip ptosis, or dropping of the nasal tip. This can make the nose appear longer and with a poor aesthetic result.
So how is the tip made stronger or how is additional support increased? Well, the best way is either anchor the medial crura on the septum of the nose if the septum has adequate length. If the septum is short, then a caudal extension graft can be placed on the septum and the medial crura can be anchored to the graft. If these two maneuvers can be performed because the septum has an intrinsic curvature, then a columellar strut can be used. This is a piece of cartilage that is placed in between the medial crura to strengthen them.
As you can see there is a lot of “anchoring” and grafting going on here, but don’t worry. These are just techniques I use to help shape the nose into a better looking and better functioning nose. These techniques are allows me to perform a better rhinoplasty result and a long lasting one at that.