Introduction
Plastic surgery for nasal columella strut implantation has gained significant popularity in New York City. With numerous experts in the field, patients are often eager to see comparison photos to understand the potential outcomes. In this article, we will delve into the details of nasal columella strut implantation, compare different techniques, and provide an in - depth look at some of the top experts in New York City along with their before - and - after photo albums.
Understanding Nasal Columella Strut Implantation
Anatomy and Function of the Nasal Columella
The nasal columella is an important aesthetic and functional unit of the nose. It is the tissue that separates the nostrils and plays a crucial role in determining the projection of the nasal tip, defining the nasolabial angle, and influencing the relationship between the nasal base and alar rims. Functionally, it provides support to the nasal tip and marks the transition from non - keratinizing squamous epithelium to respiratory ciliated columnar epithelium.
Purpose of Nasal Columella Strut Implantation
One of the main purposes of nasal columella strut implantation is to enhance the support of the nasal tip. In rhinoplasty, many procedures can compromise the columellar structure. By inserting a columellar strut, surgeons can help maintain the long - term stability of nasal projection and rotation. This can lead to a more balanced and aesthetically pleasing nasal appearance.
Techniques and Considerations in Nasal Columella Strut Implantation
Types of Grafts Used
- Autologous Septal Cartilage: This is one of the most commonly used materials for columellar strut grafts (CSGs). It is ideal because it is the patient's own tissue, which reduces the risk of rejection. It can be shaped to fit the patient's specific nasal anatomy accurately.
- Conchal Cartilage: The cartilage from the ear (conchal cartilage) can also be used. It may be preferred when septal cartilage is not available or sufficient.
- Costal Cartilage: In some cases, costal cartilage (from the ribs) is used. However, harvesting costal cartilage is a more invasive procedure and may have a higher risk of complications.
Insertion and Fixation
- The columellar strut is typically placed between the medial crura of the lower alar cartilage, along the caudal edge of the septum and abutting the nasal spine. The size and shape of the strut are crucial factors. A study by Gandy et al. used finite element analysis to examine how graft size, shape, and connectivity (suture configuration) to the medial crura affect nasal tip support. They found that larger strut volumes generally increased the reaction force (tip recoil force), indicating better support, and the strain energy density in the alar cartilages generally decreased with larger strut volumes.
- Fixation of the strut is also important. Sutures are commonly used to secure the strut to the medial crura. Different suture placement techniques can have varying effects on the stability of the strut. Anteriorly placed sutures were found to incur reaction forces similar to struts that are fully connected to the alar cartilage, suggesting that for optimal support, sutures should be placed along either the entire csg or the anterior - most portion to the alar cartilages.
Comparison of Different Approaches in Nasal Surgery
Columellar Strut vs. Septal Extension Grafts
Akkus et al. compared the effects of columellar strut and septal extension grafts for reconstruction of caudal nasal supportive structures on the long - term stability of nasal projection and rotation. Both grafts had the effect of increasing nasal projection, and this effect was stable over time. However, the tip position was more stable in cases with septal extension grafts than in those with columellar strut grafts. Some increased values of nasal projection obtained in the early postoperative period were lost over time, and the values decreased less in the group that received septal extension grafts.
Different Incision Techniques in Open Rhinoplasty
In open rhinoplasty, different columellar incision techniques are used, such as the “W” incision and the inverted - V incision. In a study by İhvan et al., they compared these two incisions using a scar assessment scale. They found that the scar pigmentation, notching, and scar formation were similar in both groups. As a result, they concluded that the inverted - V incision or “W” incision might be a similar choice in open nasal surgery.
Top Experts in New York City for Nasal Columella Strut Implantation
Dr. Andrew Jacono
Dr. Andrew Jacono is one of the top rhinoplasty surgeons in New York City. He is the surgical director of the New York Center for Facial Plastic and Laser Surgery. Renowned for his extraordinarily unique and innovative surgical approach, he has extensive training in surgical rhinoplasty. Dr. Jacono prides himself on offering the most comprehensive, natural results possible. He has pioneered less - invasive techniques that avoid breaking the nose and removing excessive cartilage, which typically risk making a nose look overdone.
Dr. Jacono is a specialist in ethnic rhinoplasty, thick - skin rhinoplasty, middle eastern rhinoplasty, and african - american and asian rhinoplasty. He has developed a customized approach to preserving ethnic identity during rhinoplasty while achieving a natural, beautiful nasal definition. His patients travel from all over the world to visit his New York City surgery center. His office has been featured on the cover of Plastic Surgery Practice Journal, one of the top plastic surgery journals in America, and many other publications. Celebrities, socialites, and even royalty have flocked to Dr. Jacono for rhinoplasty and other surgical procedures.
Before - and - After Photos
- Patient 1: Young Latina Woman: This patient was unhappy with her dorsal hump and nasal tip. Dr. Jacono refined her tip and reduced her dorsal hump, resulting in a more balanced and attractive nasal appearance.
- Patient 2: European Woman: The patient complained about her dorsal hump, bulbous tip, and droopy columella. Dr. Jacono performed a closed rhinoplasty for a softer, more feminine nasal bridge and refined nasal tip.
- Patient 3: Young Australian Woman: Unhappy with her nasal hump and nasal tip, after the procedure, she had a much softer nasal tip and a gentler dorsal hump.
- Patient 4: Hispanic Woman: With a large dorsal hump and a droopy nasal tip, Dr. Jacono performed a closed rhinoplasty to raise her nasal tip and reduce the height of her nasal bridge.
- Patient 5: A Woman with Long, Droopy Nasal Tip and Bridge Bump: Her results showed a shortened, refined nasal tip and a much softer bridge slope.
- Patient 6: Middle Eastern Woman: She was unhappy with her narrow nasal bridge, protrusive dorsal hump, wide, flaring nostrils, and long, droopy tip. After the surgery, she had a much softer, more feminine nose with a wider nasal bridge, a smoother dorsal hump, and a gentler nasal tip.
Reconstruction of Nasal Columella Defects
Indications for Reconstruction
Nasal columella defects can result from various causes, such as ischaemic injuries, trauma, tumour resection, vascular malformations, and congenital agenesis/dysgenesis of nasal anatomy. Reconstruction is often necessary to restore both the aesthetic appearance and the function of the nose.
Reconstruction Techniques
- Full - Thickness Skin Grafts (FTSGs): These can be used for superficial defects involving only the skin and subcutaneous tissue. However, deeper defects involving the medial crura usually require flap and/or composite graft coverage. FTSGs may also be considered for comorbid patients who cannot undergo a more extensive reconstruction.
- Local Flaps: Local facial flaps for columella reconstruction were first presented by Blair and Byars in 1946. They are commonly indicated for isolated full - thickness columella defects too large for composite graft reconstruction. A variety of techniques have been reported in the literature, named after their donor site, but the ideal technique still remains elusive.
- Regional Flaps: Regional flaps, including the pedicled forehead flap, the Washio flap, the submental flap, the Abbe flap, and tubed flaps, have been proposed as alternative techniques for columella reconstruction. These are particularly useful in patients with composite defects that are larger in size and may involve other nasal subunits.
- Free Flaps: Although not commonly the first choice, free tissue transfer techniques are feasible options for columella reconstruction. They are helpful in poorly accessible defects where local tissue transfer cannot be used.
Case Studies in Reconstruction
- Case 1: 4 - Year - Old White Boy: He had undergone choanal atresia repair several years previously, which resulted in pressure necrosis and eventual loss of the columellar and septal tissue. A nasofacial sulcus flap was performed. An elliptical incision was made in the nasofacial sulcus, and after mobilization, the skin island was wrapped around an auricular cartilage graft, which was used as a columellar strut. After more than 6 months, the flap was well - healed, with no contraction, and no secondary procedures were required.
- Case 2: 65 - Year - Old Man: He had a basal cell carcinoma that involved the columella, caudal septum, and upper lip. After Mohs micrographic resection, he underwent forehead flap nasal reconstruction. Septal cartilage was used as a combined caudal septal reconstruction graft and a columellar strut. Conchal cartilage was used for medial crural reconstruction and a shield - type tip graft. The forehead flap was turned in to reconstruct the mucosal covering of the caudal septum and resurface the entire nasal columella, tip, and dorsum. One year after surgery, the patient showed satisfactory results.
Considerations for Patients Seeking Nasal Columella Strut Implantation
Researching Surgeons
Patients should thoroughly research potential surgeons. Look for board - certified plastic surgeons with extensive experience in nasal surgery, especially nasal columella strut implantation. Check their reviews, testimonials, and before - and - after photo albums to get an idea of their skill level and the quality of their work.
Setting Realistic Expectations
It is important for patients to have realistic expectations about the outcome of the surgery. While nasal columella strut implantation can improve the appearance and support of the nose, the results may vary depending on individual factors such as nasal anatomy, skin type, and the extent of the procedure. Patients should discuss their goals with their surgeon and understand the limitations and potential risks of the surgery.
Recovery and Aftercare
Recovery after nasal columella strut implantation typically involves some swelling, bruising, and discomfort in the first few days to weeks. Patients should follow their surgeon's post - operative instructions carefully, which may include taking medications, keeping the head elevated, and avoiding strenuous activities. Regular follow - up appointments are necessary to monitor the healing process and ensure the best possible outcome.
Conclusion
In conclusion, nasal columella strut implantation is a complex and important procedure in plastic surgery. In New York City, there are top - notch experts like Dr. Andrew Jacono who have demonstrated excellent results through their innovative techniques and attention to detail. Different techniques, such as columellar strut and septal extension grafts, and incision techniques in open rhinoplasty, have their own advantages and considerations. Reconstruction of nasal columella defects also requires careful selection of the appropriate technique based on the type and extent of the defect.
If you are considering nasal columella strut implantation, take the time to research and consult with a qualified surgeon. Ask to see their comparison photo albums to understand the potential outcomes. Share your concerns and goals openly with your surgeon, and follow their pre - and post - operative instructions for a successful and satisfying surgical experience. Don't hesitate to reach out to multiple surgeons for second opinions and make an informed decision that is right for you.
