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Agrawal et al. Plast Aesthet Res 2018;5:13 Plastic and
DOI: 10.20517/2347-9264.2018.17 Aesthetic Research

Letter to Editor Open Access

Use of “tent-pole” graft for setting columella-lip
angle in rhinoplasty

Kapil Agrawal, Raghav Shrotriya
Department of Plastic Surgery, KEM Hospital, Mumbai 400012, India.

Correspondence to: Dr. Raghav Shrotriya, Department of Plastic Surgery, KEM Hospital, Gynec. Wing, 2nd Floor, Parel, Mumbai
400012, India. E-mail: dr.raghav.s@gmail.com
How to cite this article: Agrawal K, Shrotriya R. Use of “tent-pole” graft for setting columella-lip angle in rhinoplasty. Plast
Aesthet Res 2018;5:13. http://dx.doi.org/10.20517/2347-9264.2018.17
Received: 26 Mar 2018 Accepted: 26 Mar 2018 Published: 18 Apr 2018

Science Editor: Raúl González-García Copy Editor: Jun-Yao Li Production Editor: Cai-Hong Wang

Sir,
In patients of rhinoplasty, columella-labial angle (CLA) is an important parameter to be evaluated if a
pleasant aesthetic result is desired. An increase in this angle results in an upward tilt of the base of the nose
with a concomitant decrease in nasal length. Owing to the wide anatomic variability, it is often times missed,
thereby leading to sub-optimal surgical results.

The relationship between the columella and upper lip is complex. Trying to maintain a particular angle in
patients of rhinoplasty is difficult and entails use of various manoeuvres like suturing techniques, cartilage
grafts and nasal cartilage modifications. The caudal septum, nasal spine and medial crura of the lower lateral
cartilages help shape the columella and thus contribute to the determination of the CLA . On profile view,
[1]
the desired columella-labial angle is 95° to 100° in men and 100° to 110° in women . The normal columellar
[2]
show ranges from 2 to 4 mm. A long or hanging columella can significantly disturb the aesthetic effect of
the nose. Here the authors describe ‘the tent pole graft’, an innovative technique used to set and maintain
the columellar lip angle.

The “tent-pole graft” works in a manner similar to the septo-columellar interpositional grafts but here there
is no need to dissect or separate upper lateral cartilages from septum to fix the grafts. This graft is akin to
fixing a bamboo of a tent in position. It is used in difficult secondary noses and cases where tip projection is
increased significantly by putting long columellar strut, which tends to fall back (as in Binder’s syndrome).

In this technique, a piece of cartilage is fixed to columellar strut in a desired position and then the optimal
angle is chosen by fixing the posterior end of graft temporarily with a needle to supratip cartilaginous

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