Medial crural footplate crease approach for columellar strut graft placement in closed rhinoplasty.

The placement of a columellar cartilage strut graft (CSG) between the medial cartilage crura is an important step for providing tip projection and support in rhinoplasty. While the CSG is placed by direct observation in open rhinoplasty, it can be placed with different approaches in closed rhinoplasty: by dissection from the mucosal side, delivery technique, marginal or lateral incisions from the edge of the columella, direct skin incisions over the columella, or incisions made through the intraoral mucosa. This study suggests the placement of the CSG through a medial crus footplate crease incision as an alternative approach in closed rhinoplasty. A septal cartilage graft is harvested and fashioned into a 16-22 mm long CSG for later insertion. A 3-mm incision is made at the junction of the nasal floor and the lip, at the level of the lower end of the right medial crural footplate. A minimal dissection is performed between the medial crura to the tip using a blunt periosteal elevator, following which the CSG is inserted. This procedure is easy and provides adequate support for the columella and tip without prolonging the operation time. The scar is hidden in the natural fold and heals very well.