Double Columellar Strut: Who, When, and How-Clinical Technique and Outcomes

Objectives: Achieving the desired long-term results in terms of nasal tip projection and rotation is challenging in rhinoplasty. To improve upon the stability and strength of tip support compared with conventional single-strut grafts, the Double Columellar Strut Graft (DCSG) technique was devised. We reviewed DCSG and assessed its effectiveness, safety, and outcomes in primary and revision rhinoplasty. Methods: This retrospective study examined the outcomes of 42 patients who underwent DCSG-assisted open rhinoplasty between 2020 and 2023. Of these patients, 27 were primary cases, and 15 were revision cases. The Goode ratio, the columellar-labial angle, the NOSE scores, and scores from independent photography evaluations were used to compare pre- and postoperative results. On average, patients were followed up for 18 months. Results: Following surgery, there was an increase in tip projection (Goode ratio) and columellar-labial angle (median: 85.0 °–96.0 °) in all patients, including those undergoing primary and revision rhinoplasty ( P <0.05). After surgery, NOSE scores declined compared with preoperative values (22.0 versus 13.0) ( P <0.05). Results of independent photographic evaluation also improved after surgery, increasing from 4.0 before to 8.0 after ( P <0.05). In our comparison of the 2 groups, we found that the primary rhinoplasty group had significantly higher tip projection ratios than the revision rhinoplasty group at both the preoperative and postoperative periods ( P <0.05). Graft visibility, extrusions, or infections were not detected. Conclusion: Consistent, repeatable outcomes with few side effects are possible with the DCSG. Particularly useful for revision and thick-skin rhinoplasty, its mechanical strengthening of the medial crura improves projection control and visual consistency.