A columellar strut consists of a rectangular piece of cartilage placed between the medial crura of the tip cartilages. The surgeon may place a strut if the nasal tip needs additional support or strength. This strut provides additional strength to the tip and may provide some degree of tip elevation (projection and rotation).

Plumping grafts can be a helpful technique if the junction of the nose to the upper lip is retracted or "acute," which may be modified by placing "plump­ing" grafts beneath the skin in this location. Throughan incision inside the nose, bits of the patients own cartilage (usually taken from the nasal septum) may be placed at the base of the naso-labial angle. This can improve an overly sharp angle there. This sharp angle is often seen in an "aging" nose (Fig. 26).

V.F. Base Resection

Base resection is a technique that is useful if the nose is too wide at the bottom. If this is the case, a portion of the nostril at the base may be removed to narrow it. This is called an alar base resection (Fig. 27).

FIGURE 22. A bulbous tip may be addressed with suture techniques. The suture technique illustrated here was used in this patient. (a,b) Preoperative, (c,d) postoperative.

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