title: The dorsal columellar strut: innovative use of dorsal hump removal for a columellar strut.
abstract: BACKGROUND
  Dorsal hump reduction is a common complaint among primary cosmetic rhinoplasty patients. Newer techniques for addressing the dorsal hump focus on the preservation, reinforcement, or modification of existing structures.
  
  
  OBJECTIVE
  The authors describe their technique of a "dorsal columellar strut," an innovative use of dorsal nasal cartilage from hump removal for a columellar strut. Combined with other cartilage-conserving techniques, this forgoes the morbidity and operative time of a septal cartilage harvest while preserving--and possibly increasing--tip support.
  
  
  METHODS
  Candidates for this procedure are selected based on a number of criteria. Ideally, the patient is one who requires 3 mm or more of dorsal hump reduction with tip reshaping and refinement. Each patient is treated using the open technique with a stair-step columellar incision, combined with an infracartilaginous incision.
  
  
  RESULTS
  With the addition of the authors' cartilage-conserving techniques (autospreader flap, lower lateral turnover, and tip suturing), patients experience successful reshaping of the middle vault and nasal tip.
  
  
  CONCLUSIONS
  In well-selected patients, the authors have found their technique to be efficient, effective, and aesthetic. The precise dorsal reduction allows surgeons to use the cartilage fragment as a dorsal columellar strut, foregoing the standard septal harvest and reducing operative time and patient morbidity.
authors.affiliation: Department of Plastic Surgery, UT Southwestern Medical Center, 1891 Inwood Road, Dallas, TX 75390, USA. Rod.Rohrich@UTSouthwestern.edu
authors.forename: Rod J
authors.initials: RJ
authors.lastname: Rohrich
authors.forename: Jerome H
authors.initials: JH
authors.lastname: Liu
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D055171:Nasal Cartilages / Q000601:surgery; D009666:Nose / Q000601:surgery*; D012225:Rhinoplasty / Q000379:methods*