[Dr. Koh Seung-jo's Lecture Notes] Septal Extension Graft Part 2

#septum #septalextensiongraft #columella #columellacorrection #columellarstrut #nasolabialangle #nosesurgery #rhinoplasty #nosetip #autologouscartilage #wevers #seoseungjo #shimjunghwan #parksunhee #nose

Hello.

💖your beauty universe! This is Dr. Seo Seung-jo from Wevers Plastic Surgery :)💖

Today, we will learn about the columellar strut, one of the methods to beautifully raise the nose tip.

The necessity of septal extension graft and columellar strut?

When nose surgery is performed with only a columellar strut,

it can easily sway up or down,

or from side to side.

That is why

it is connected with a septal extension graft.

In other words, in an unstable state,

when a septal extension graft is applied,

it becomes more stabilized.

This is a side view of the nose.

The part marked in mint green is the alar cartilage.

Originally, the alar cartilage and septal cartilage

function separately.

They move independently.

In that case, if we assume ‘a strut is erected’,

you would generally think it is erected in this direction.

If the strut is erected in the direction shown in the diagram,

when force is applied to the outside of the nose or the columellar area, as indicated by the arrows,

it can withstand it well.

But what is the problem?

If there is only a columellar strut,

assuming there is no septal connection,

it can easily sway up and down,

and from side to side.

If a columellar strut is used alone here,

its characteristic is that the nose tip might feel soft,

but conversely, it can be unstable.

Therefore, it is extended in conjunction with a septal extension graft.

When the septum is connected,

it stabilizes the forces that cause movement from side to side and up and down.

Thus, this instability can be stabilized.

In other words, when a septal extension graft is used,

it becomes more stable.

Q: How is the columellar strut fixed?

The columellar strut can also be firmly fixed to the bone,

which is called ‘fixed’.

It can also be left ‘floating’.

In the case of the fixed type,

because it firmly props up the septum,

when you press the nose tip, it moves up and down and side to side,

but when pressed, it does not collapse because it is firmly held.

But what about the floating method?

Since this much is not fixed,

this much can move inwards.

There is a difference in advantages and disadvantages.

In conclusion,

to significantly raise the nose tip,

a columellar strut alone is often insufficient,

so the septal extension graft method is frequently used.

This is also why the septal extension graft method is widely used.

Q: What if only a septal extension graft is performed, but a large amount of septal cartilage cannot be harvested?

When an extension graft is used alone,

the direction receiving support must not be weak.

The septal extension graft must be connected in a way that allows it to act as a support,

only then can the nose withstand well.

However, if only a septal extension graft is performed,

and a large amount of cartilage cannot be harvested,

what is needed is

cartilage grafting using the columellar strut method.

Only in this way can the nose tip be made higher

and more defined,

and the optimal nasolabial angle

can be reliably corrected.

Of course, the nose tip can be raised with only a columellar strut.

The biggest advantage is that it is ‘soft’,

but since it can be somewhat unstable,

it cannot be raised very high.

This concludes my detailed explanation of the columellar strut and septal extension graft.

Next time, I will return with more detailed and new information.

https://www.youtube.com/watch?v=QPs808dDvao

💖If you have any further questions?

Frequently Asked Questions

What are the characteristics of using only a columellar strut?

The advantage is that the nasal tip feels soft, but it can be somewhat unstable, swaying up, down, left, and right. Since there are limitations to significantly raising the nasal tip with only a strut, it is recommended to consider septal extension graft together if you want a higher and more stable nasal tip.

Why is septal extension graft performed together?

It is to support the nasal tip more firmly and stably. Septal extension graft prevents the up, down, left, and right swaying that occurs when only a columellar strut is used, playing an essential role in sufficiently raising and stabilizing the nasal tip to the desired extent.

What are the fixation methods for columellar struts?

There are Fixed and Floating methods. The Fixed type is firmly secured and does not move inward when the nasal tip is pressed, while the Floating type can move inward as it is not fixed, each having different advantages and disadvantages.

What if the amount of septal cartilage that can be harvested is small?

Cartilage grafting using the columellar strut method can be performed together to reinforce support. If the septal extension graft alone lacks sufficient support, adding a columellar strut can make the nasal tip higher and more defined, while effectively correcting the nasolabial angle to an optimal degree.