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Page 2 of 5 Agrawal et al. Plast Aesthet Res 2018;5:13 I http://dx.doi.org/10.20517/2347-9264.2018.17

Figure 1. Picture in lateral view of a patient who underwent rhinoplasty, showing temporary fixation of the tent pole graft to set the columella
labial angle using needle

Figure 2. Schematic diagram corresponding to Figure 1, showing temporary cartilage graft fixation using needle so that it can be increased
or decreased easily by sliding

dorsum [Figures 1 and 2]. Once sure of the angle, the graft is sutured to the dorsum [Figures 3 and 4].
Tent pole graft keeps long columellar strut stable and doesn’t allow the tip to fall back. It not only helps in
maintaining but gives a liberty to create a CLA of choice. Authors usually use it whenever tip support is
needed in secondary rhinoplasties and cases where lengthening of tip or columella is done, to maintain the
desired columellar-labial angle, and to maintain the nasal length in patients with short noses. This graft can
be moved serially to easily adjust the nasolabial or columella-labial angle. To avoid supratip show of the graft
the dorsal limb of the graft is placed and fixed to columellar strut 3-4 mm lower than the actual tip height.
The tent pole graft is a variant of L-strut. An L-strut can be used to serve the same purpose of creating and
maintaining a CLA of choice, but tent pole graft, which is fixed in supratip region, provides the liberty to