The value of spreader grafts in rhinoplasty cannot be underestimated. Various studies have demonstrated that they play a valuable role in the restoration of nasal dorsum aesthetics, provide support for the nasal valve and maintain the straightened position of the corrected deviated cartilaginous septal dorsum. However, there is still controversy on the extent of its value in nasal patency. This study reviews the literature and describes the values and limitations of spreader grafts in rhinoplasty and the alternatives to classic spreader grafts.

Background: Rhinoplasty is one of the most challenging esthetic surgeries. The ability to achieve precise and predictable changes in the shape and position of the nasal tip is still among one of the demanding areas of rhinoplasty. Columellar strut is one of many techniques to ensure an adequate nasal tip projection and rotation; however, there is little evidence to support long-term efficacy of this technique. Methods: In a clinical trial, 93 patients who were rhinoplasty candidates were studied prospectively. They were randomly divided into two groups according to the use of columellar strut. The outcome measures were gaining and maintaining tip projection and rotation in the long term. Standardized photographs before and 3, 6, and 12 months after surgery were the measurements to compare the results between two groups. Results: The mean age was 23.3 ± 4.8 years. In 47 cases, surgery was performed using columellar strut and in 45 cases this method was not used. Preoperatively, nasolabial angle and tip projection were not significantly different between the two groups. In addition, postoperatively, the mean of nasolabial angel and tip projection were not significantly different in the two groups 3, 6, and 12 months after surgery. The decreasing of these parameters was not significantly different during follow-up in the two groups. Conclusion: It seems that columellar strut is not an essential technique to enhance and maintain tip projection and/or rotation in rhinoplasty. Using good techniques in qualified hands give the best results in the long term even without columellar strut.