Triple Strut Concept for the Nasal Tip Projection in Small Lower Lateral Cartilages and Septum

INTRODUCTION: This study aimed to evaluate the effectiveness of the triple strut graft technique for nasal tip projection in Asian patients with weak and small lower lateral cartilages and septum. The technique uses a combination of septal angle strut and, columellar strut grafts and lateral crural repositioning to provide support for the nasal tip. METHODS: The study included 30 Asian patients who underwent primary rhinoplasty using this technique between January 2019 and December 2021. The surgical procedure involved making an open rhinoplasty incision and performing a scroll area release. A small triangular-shaped septal angle strut graft was then placed, and the lower lateral cartilages were suspended anteriorly and placed on the anterior end of the septal angle after a columellar strut graft was performed between both medial crura. The lateral crura of the lower lateral cartilages were transposed medially on top of the upper lateral cartilages and maintained in place by spanning sutures at the cephalic margins of both lateral crura. RESULTS: The triple strut graft technique was shown to be effective in providing stable tip projection in Asian noses with weak and small lower lateral cartilages and septum. Statistically significant differences were found between the preoperative and postoperative values of the nasal tip projection ratio and Rhinoplasty Outcome Evaluation (P < 0.05). CONCLUSIONS: The triple strut graft tip projection technique can be an effective surgical option for Asian patients who have weak and small medial crura combined with a small septum, providing stability for the nasal tip projection.