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Plastic and Reconstructive Surgery
s !PRIL
and the columella is soft, mobile, and flexible.
Although relying on medial crural strength for
nasal tip support/projection can be a surgically
successful strategy in selected rhinoplasty cases,
it is also associated with clinically significant but
infrequently discussed sequelae such as nasal tip
rigidity and loss of columellar flexibility.
10,12
Rohrich et al. have classified columellar strut
grafts and proposed a clinical algorithm for their
application.
12
They recommended using either
type 3 (long and floating) or type 4 (long and
fixed) columellar strut grafts for increasing nasal
tip projection. Although nasal tip projection can
be stabilized or increased with the use of a long
columellar strut, this occurs at the expense of a
rigid and fixed columella. In our experience,
patients who undergo reconstruction with a long,
fixed columellar strut may complain of difficulty
wiping their nose, or the nose may be felt like a
stick on the cheek when kissing.
Table 6. Repeated Measures Analysis of Variance, Goode Ratio, and Overall Study Population*
(I) Time
(J) Time
Mean Difference (I − J)
p
†
Preoperative GR (0.61 ± 0.048),
n
= 100
GR morphed
−0.053‡
0.0001‡
GR postoperatively
−0.060‡
0.0001‡
Morphed GR (0.66 ± 0.039),
n
= 100
GR preoperatively
0.053‡
0.0001‡
GR postoperatively
−0.007‡
0.0001‡
Postoperative GR (0.67 ± 0.039),
n
= 100
GR preoperatively
0.060‡
0.0001‡
GR morphed
0.007‡
0.0001‡
GR, Goode ratio.
*Descriptive statistics and pairwise comparisons, based on estimated marginal means.
†With Bonferroni adjustment for multiple comparisons.
‡The mean difference is significant at the 0.05 level.
Table 7. Repeated Measures Analysis of Variance, Nasolabial Angle, Overall Study Population*
(I) Time
(J) Time
Mean Difference (I − J)
p
†
Preoperative NLA (92.4 ± 10.3),
n
= 100
NLA morphed
−9.020‡
0.0001‡
NLA postoperatively
−8.980‡
0.0001
Morphed NLA (101.5 ± 6.1),
n
= 100
NLA preoperatively
9.020‡
0.0001‡
NLA postoperatively
0.040
1.000
Postoperative NLA (101.5 ± 6.7),
n
= 100
NLA preoperatively
8.980‡
0.0001‡
NLA morphed
−0.040
1.000
NLA, nasolabial angle.
*Descriptive statistics and pairwise comparisons, based on estimated marginal means.
†With Bonferroni adjustment for multiple comparisons.
‡The mean difference is significant at the 0.05 level.
Fig. 3.
Examples of postoperative columellar contour irregularities
in the absence of columellar strut grafts. Unwanted bowing of intrin-
sically weak medial crura (
left
) and columellar notching beneath the
transcolumellar incision (
right
).