Can the Strut technique keep the nasal tip high? Expectations and limitations revealed by research

The Strut technique (a method of placing a cartilage strut in the columella) is widely used as a method to support the nasal tip, but reports indicate that the effect of raising the nasal tip is inconsistent[1][2]. Multiple comparisons show that septal extension has superior long-term nasal tip stability[2][3]. However, this answer changes depending on how the strut is fixed and its intended purpose[4].

What does the Strut technique do to the nasal tip?

The Strut technique is a method of standing cartilage in the columella (the wall between the nostrils) to support the nasal tip from below. It is used to achieve changes such as projecting the nasal tip forward, lengthening the columella, and widening the angle below the nose[5].

When a long strut is firmly fixed, it can strongly support the nasal tip, but the nasal tip becomes stiffer as a result[5]. If the strut is too long and the area above the nostrils rises too much, the balance of the nasal tip can be disrupted[5].

Does the nasal tip actually become higher? Research figures vary

According to research, it cannot be said definitively that the nasal tip becomes higher with the Strut technique alone. In a survey introduced in a report summarizing research on nasal surgery, 65% of patients showed a decrease in nasal tip height after the Strut technique, 27% showed an increase, and 8% showed no change[1].

The angle below the nose widened in 46%, narrowed in 34%, and remained unchanged in 20%[1]. With figures that split outcomes into three patterns across 100 patients, it is clear that the position of the nasal tip is not determined by the strut alone.

Another study comparing 6 months and 18 months post-operatively found that nasal tip height initially increased and then decreased slightly, but the difference was not significant[6]. On the other hand, the upward angle of the nasal tip clearly reversed after initially increasing with the Strut technique[6].

How does it compare to septal extension?

Reports emphasize that septal extension has an advantage in long-term nasal tip stability. In a comparison following 87 patients for up to 4 years, both methods raised the nasal tip, but septal extension maintained the nasal tip position more stably over time[2].

Comparisons by experienced surgeons also show that septal extension is superior for nasal tip stability, with the Strut technique positioned as an auxiliary method[3]. There is also a point that Asian noses may require a firmer support to maintain the nasal tip[7].

Does the outcome change depending on how it is fixed?

The outcome of the Strut technique changes depending on where the strut is fixed. One analysis found that if the strut is not fixed to the end of the nasal septum or does not reach the bone base, the nasal tip height does not turn out as desired[4].

The Strut technique produces height only when designed for the purpose of raising the nasal tip, so it should be used selectively on patients who need it[2]. A fixed strut also serves the role of preventing weak cartilage from collapsing or twisting[5].

What research tells us and what remains unclear

What can be said is that "maintaining height with the Strut technique alone is difficult, and results vary depending on the combination of purpose." While there are over 4,000 papers on nasal grafting, few studies directly compare the Strut technique and septal extension[2].

Even in a comparison reviewing 165 patients, there is reportedly little basis for determining which method is best[8]. It is also important to note that most are retrospective studies from single institutions, and differences in cartilage used and surgeon skill are mixed into the results.

Whether the Strut technique is right for your nose cannot be determined from an article alone. During consultation, communicate how much you want to raise your nasal tip and how much stiffness you can tolerate, and discuss with your surgeon the differences between septal extension and how the strut will be fixed.