COSMETIC

Superiority of the Septal Extension Graft

over the Columellar Strut Graft in Primary
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Rhinoplasty: Improved Long-Term Tip Stability

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Justin L. Bellamy, MD
Background: Columellar strut grafts and septal extension grafts are commonly
Rod J. Rohrich, MD used support structures; however, their relative effectiveness remains debated.
Dallas, TX The purpose of this study was to compare the long-term stability of septal exten-
sion grafts to that of columellar strut grafts.
Methods: A retrospective review of all primary rhinoplasties performed by the
senior author (R.J.R.) from 2016 to 2019 was performed. All adult patients
undergoing primary open rhinoplasty with at least 1 year of follow-up were
included. Revision cases and those in whom rib grafts were used were excluded.
Standardized postoperative imaging was assessed at 2 months (early) and at
12 months (long-term) to measure projection/rotation change over time.
Univariate and multivariable statistical comparisons were performed.
Results: The chart query yielded 133 patients. Of these, 40 patients were treated
with a columellar strut and 37 patients were treated with a septal extension
graft. Projection loss at 1 year was 4.7% for the columellar strut group com-
pared with 0.2% for the septal extension graft group (P < 0.0001). On multivari-
able logistic regression, there was a 5.1-fold increased risk of greater than 4%
projection loss when using a columellar strut (P < 0.005). Mean rotation loss for
the columellar strut group was 4.9 degrees compared with 1.3 degrees for the
septal extension graft group (P < 0.0001). The independent effect of columel-
lar strut use resulted in a 2.8-fold increased risk of rotation loss greater than or
equal to 5 degrees (P < 0.05).
Conclusions: Septal extension grafts result in effectively no loss of projection
and minimal loss in rotation. A small degree of projection and rotation loss
can be expected with the use of a columellar strut alone. These long-term graft
tendencies should be anticipated and accounted for appropriately. (Plast.
Reconstr. Surg. 152: 332, 2023.)
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

I
n an operation of millimeters, optimized nasal
tip control, consistency, and stability over time
remain essential components of excellent and
long-lasting rhinoplasty results. Although the ideal
rhinoplasty approach has been debated exten-
sively, open rhinoplasty provides the best visual-
ization of (and access to) the malpositioned or
deformed nasal anatomy, at the expense of some
degree of disruption of ligamentous architecture
when compared with the endonasal approach.1
For this reason, regardless of tip shaping goals, it
From the Dallas Plastic Surgery Institute.
Received for publication January 17, 2021; accepted May
24, 2022.
Copyright © 2023 by the American Society of Plastic Surgeons
DOI: 10.1097/PRS.0000000000010147
is beneficial to resupport the tip elements at the
time of rhinoplasty with structural tip grafts.2–4
When further attempting to manipulate tip posi-
tion, projection, or shape, structural tip grafts
become an essential and powerful tool. It follows
that the value of a structural tip graft is directly
related to its capacity to affect and maintain tip
position over time.
Two structural tip grafts fulfill this role as a
central scaffold: the columellar strut graft and
the septal extension graft. The columellar strut
graft is typically secured in a soft-tissue pocket
made between the medial crura, extending
Disclosure statements are at the end of this article,
following the correspondence information.

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 Volume 152, Number 2 • Superiority of Septal Extension Grafts

toward but not directly abutting the anterior
nasal spine, and sutured directly to the medial
crura cartilage. It directly augments the colu-
mella to support the tip position. Alternatively,
the septal extension graft takes advantage of the
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against the fixed-floating septal extension graft.
We hypothesized that the columellar strut graft
would have greater loss of projection and rota-
tion between the early and late postoperative
periods.

much more robust caudal septal cartilage as a

securing post. Several modifications have been
described; however, the most commonly used
are as follows: (1) sutured abutting the caudal
L-strut and extending beyond the anterior septal
angle to directly set the new tip position,5 or (2)
as direct caudal septal extensions6 without direct
overlap. We prefer and use the former/abutting
version, which can control tip position depen-
dent on its angle of placement (Fig. 1). Although
some use this graft bilaterally (on both sides of
the septum) and/or secure the graft to the ante-
rior nasal spine (termed “fixed”), we find that
this creates a stiff and bulky construct. We prefer
to use the septal cartilage graft unilaterally and
“floating” above the anterior nasal spine, sim-
ply secured with enough overlap of the anterior
nasal angle to provide a stable post. This “fixed-
floating” construct has minimized the limitations
of the septal extension graft while taking advan-
tage of the enhanced stability.
At present, both columellar strut and sep-
tal extension grafts are widely used support
structures; however, their relative effectiveness
remains debated.7–10 In 2018, we transitioned
from primarily using the columellar strut graft
to primarily using the septal extension graft. The
purpose of this study was to evaluate the relative
long-term stability of the columellar strut graft
PATIENTS AND METHODS
A retrospective cohort study of all patients
undergoing open primary rhinoplasty performed
by the senior author (R.J.R.) between June of
2016 and November of 2019 was undertaken with
institutional review board approval. These dates
encompassed a 3.5-year interval centered around
a change in the senior author’s practice from
primarily using columellar strut grafts to primar-
ily using the septal extension graft to support
tip position, while also allowing at least 1-year
follow-up for all patients at the time of study
execution (December of 2020). Inclusion crite-
ria included all adult patients undergoing pri-
mary open rhinoplasty. To minimize the complex
array of confounding variables, this study focused
on primary rhinoplasty and excluded revision
cases and those using fresh frozen rib graft, as
these patients tend to represent a distinct group
of rhinoplasty patients. In addition, patients
who also underwent tip grafting were excluded
to reduce introduced confounding. Patients
undergoing simultaneous face lift with rhino-
plasty were excluded, as the intratragal incision
directly involves a reference point used in photo-
graphic comparison (as subsequently discussed).
Patients without adequate short- and long-term

Fig. 1. Example of digital measurements. (Left) Relative pixel position x and y coordinates of the most projecting point of tip, where
the alar base represents pixel coordinates (0 and 0). Tip projection in pixels is determined trigonometrically with these coordinates.
(Center) Reference distance of tragus-to-cornea distance determined similarly and used to normalize tip projection measurements
between photographs. (Right) Nasolabial angle measurement using the points where the Cupid’s bow meets the vermilion border,
the posteriormost aspect of the nostril aperture, and a line tangential to the long axis of the ala.

333
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 Plastic and Reconstructive Surgery • August 2023
photographically documented follow-up were
excluded. Demographic information (age, sex,
race) and specific intraoperative interventions
were extracted from chart review. Collected
intraoperative interventions included tip support
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grafts used (columellar strut, septal extension, or
none), adjunct tip grafts used (infratip, shield),
whether the lower lateral cartilages were tran-
sected, and whether alar bases resections were
performed.
Patient Photography Assessment
All photographic comparisons were made
between the “early” and “late” postoperative
periods, defined as 2 months and 12 months,
respectively. In addition, each patient’s photo-
graphs were assessed preoperatively to allow
rhinoplasty-type classification. All photographs
were standardized professional photography
images assessed on true profile. Measurements
were performed in a blinded fashion by a single
reviewer (J.L.B.) for each side of the face, nor-
malized, and averaged. Images were evaluated
digitally using a standard 1920 × 1080–pixel reso-
lution monitor in full-screen mode. Digital mea-
surements of projection (pixels) and rotation
(degrees) were performed using the graphic
measurement tool PicPick (NgWin, v5.1.3), as
shown in Figure 1.
Projection was defined as the distance from
the posteriormost aspect of the ala to the most
projecting point of the tip (Fig. 1, left). To
account for mild variability in subject distance
between photographs, a static measurement
distance between photographs was required to
normalize measurements. We used the distance
between the posteriormost aspect of the tragus
and the anteriormost aspect of the cornea as the
normalizing measurement (Fig. 1, center), as it
was consistently available in all images and unaf-
fected by the surgical operation or healing pro-
cess over time.
Rotation was measured as the nasolabial angle,
defined as the angle between the points where
the Cupid’s bow meets the vermilion border, the
posteriormost aspect of the nostril aperture, and
a line tangential to the long axis of the ala (Fig. 1,
right). Although this value is consistently more
acute than typically discussed nasolabial angle val-
ues, we found this the most consistent way to mea-
sure nasolabial angle in photography. Because all
statistical evaluation were relative comparisons,
consistency between measurements was the most
important feature.
334
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Surgical Method
All patients underwent a standardized and
algorithmic open rhinoplasty approach, with
open septal cartilage harvest, component dorsal
reduction, percutaneous osteotomy, tip shaping
with suture, cephalic trim, and graft techniques
(as indicated), followed by alar base resec-
tion (as indicated). All grafts used were of the
patient’s own cartilage. In a minority of cases,
medial crural transection was performed when
required to decrease projection and/or improve
tip shape. Columellar strut grafts were sutured
with 5-0 polydioxanone into a pocket between
medial crura without directly abutting the ante-
rior nasal spine. Septal extension grafts were
placed unilaterally and as a fixed-floating septal
extension graft, secured to the lateral wall of the
caudal L-strut with several 5-0 polydioxanone
sutures and without directly abutting the nasal
floor (Fig. 2).
Statistical Analysis
Differences in baseline characteristics com-
paring columellar strut and septal extension
graft arms were examined using two-sample t
tests for continuous variables. For categorical
variables, a chi-square or Fisher exact test was
used.
Using univariate unadjusted models, we
analyzed the effect of using the columellar strut
graft rather than the septal extension graft
on the risk of clinically significant projection
loss. For the purposes of quantifying the risk
of clinically significant projection loss, “clini-
cally significant projection loss” was defined as
greater than 4% projection loss (or approxi-
mately 1.5 mm). Subsequently, the indepen-
dent effect of using a columellar strut graft
on the risk of clinically significant projection
loss was estimated using a multivariable logistic
regression model to control for confounding
bias. Variables were considered for inclusion
as relevant confounders if they were statisti-
cally significantly associated (P < 0.1) with both
the exposure (graft type) and the outcome
(projection loss). In addition, variables that
failed these criteria but were considered clini-
cally relevant were included. This exploratory
analysis resulted in inclusion of male sex and
rhinoplasty type as confounders, as the other
collected variables failed to meet model selec-
tion criteria. All statistical analyses were per-
formed using Stata/SE, version 12 (StataCorp,
College Station, TX).
 Volume 152, Number 2 • Superiority of Septal Extension Grafts
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Fig. 2. (Left) Fixed-floating septal extension graft placement abutting the caudal septum. Graft
placement can be declined as low as 45 degrees (relative to the dorsum) to derotate the nose,
or angled at 90 degrees or more to rotate the nose. (Right) Four key sutures secure position and
stabilize rotation. (Illustration by Edward Chamata, MD. Copyright © 2023 by Rod J. Rohrich, MD.)

RESULTS Table 1. Baseline Characteristics

Septal Columellar
Baseline Characteristics Extension Strut Graft
Chart query yielded 133 unique patients who Graft (%) (%) P
met inclusion and exclusion criteria. Of these, 40 No. 37 40
patients were treated with a columellar strut graft, Demographics
and 37 patients were treated with a septal exten-  Mean age, yr 30.2 33.4 0.851
sion graft, with the remainder receiving tip sutur-  Male sex, % 5.4 22.5 <0.05a
ing alone. Women represented 86% of the study  White race, % 78.4 57.5 0.051
Intraoperative factors, %
cohort, with 67% of patients being white, and the
 Crural transection 13.5 5.0 0.194
mean age was 32 years. Baseline characteristics for
 Alar base resection 54.0 45.0 0.427
the columellar strut group versus the septal exten- Rhinoplasty projection
sion group patients are shown in Table 1. There ­classificationb
was no significant difference in demographic char-  Neutral rhinoplasty (45%) 13 (35.1) 22 (55.0) 0.125
acteristics between the two groups, with the excep-  Deprojection 15 (40.5) 14 (35.0) 0.125
tion of male sex. There was a greater representation rhinoplasty (37%)
of men in the columellar strut group (22.5% ver-  Increased projection 9 (24.3) 4 (10.0) 0.125
rhinoplasty (17%)
sus 5.4%; P < 0.05). There were no significant dif- Rhinoplasty rotation
ferences in surgical techniques used between the ­classificationc
two groups, including lower lateral cartilage tran-  Neutral rhinoplasty (45%) 24 (64.9) 11 (27.5) <0.005a
section, alar base resection, or use of adjunct tip  Derotation 1 (2.7) 3 (7.5) <0.005a
grafts. There was no difference in rhinoplasty pro- rhinoplasty (5%)
jection type between study groups; however, there Increased rotation 12 (32.4) 26 (65.0) <0.005a
rhinoplasty (49%)
was a greater representation of patients undergo- a
Statistical significance of at least P < 0.05.
ing rotation, increasing rhinoplasty in the columel- b
Projection-type classification according to threshold of ±4% from
lar strut group (65% versus 32%; P < 0.005). preoperative to early postoperative period.
c
Rotation-type classification according to threshold of ±5 degrees
from preoperative to early postoperative period.
Tip Position
Univariate analysis results for tip position are Projection
shown in Tables 2 through 5, and multivariable Measured projection loss at 1 year was 4.7%
analysis results are shown in Table 6. These are for the columellar strut graft group compared
summarized below. with 0.2% for the septal extension graft group

335
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 Plastic and Reconstructive Surgery • August 2023

Table 2. Projection Loss (Unadjusted) (N = 77) Table 3. Rhinoplasty Type Classification

Mean Projection Mean Projection (Unadjusted)a
Loss (%) Loss (%) P Mean Loss
Demographics No. Degrees P
 Race White [52 (2.8)] Nonwhite [25 (2.4)] 0.683
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 Sex Male [11 (6.5)] Female [66 (1.9)] <0.0001a Intraoperative projection type 0.064
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Intraoperative  Neutral 35 3.1

factors
 Crural Yes [7 (1.5)] No [70 (2.6)]
transection
 Alar base Yes [38 (2.4)] No [39 (2.7)]
resection
 Graft type SEG [37 (0.2)] CS [40 (4.7)]
SEG, septal extension graft; CS, columellar strut graft.
a
Statistical significance of at least P < 0.05.
(P < 0.0001). Male sex was also significantly asso-
ciated with projection loss, with an average 6.5%
projection loss at 1 year compared with only 1.9%
in women (P > 0.0001). Other demographic vari-
ables (age, race), and surgical variables (crural
transection, alar base resection), were not signifi-
cantly associated with projection loss.
Summary of unadjusted univariate logistic
regression results are shown in Tables 2 and 3.
The cumulative incidence of clinically significant
projection loss (>4%) was 55% in columellar strut
graft patients compared with only 8% in septal
extension graft patients (P < 0.0001). Male sex was
also significantly associated with clinically signifi-
cant projection loss compared with women (73%
versus 26%; P = 0.002). On subgroup analysis by
graft type, the cumulative incidence of clinically
significant projection loss was 88.9% for men in
the columellar strut group, whereas there were no
cases for men in the septal extension graft group.
Multivariable logistic regression results for the
risk of clinically significant projection loss (defined
at >4% loss) are shown in Table 6. After adjusting for
patient sex and intraoperative projection changes,
the independent effect of columellar strut use
resulted in a 5.13-fold increase in the risk of clini-
cally significant projection loss compared with the
use of a septal extension graft (95% CI, 1.64 to 16.0;
 Deprojection 29 1.6
0.776  Projection 13 1.1
a
Projection-type classification according to threshold of ±4% from
0.634 preoperative to early postoperative period.
<0.0001a
P < 0.005). Male sex conferred a 1.83-fold increased
risk of clinically significant projection loss, indepen-
dent of graft type used or intraoperative projection
changes (95% CI, 1.03 to 3.26; P = 0.05).
Rotation
Summary of rotation loss outcomes are shown
in Tables 4 and 5. Measured rotation loss at 1 year
was significantly greater with the use of a colu-
mellar strut graft, with patients on average losing
4.9 degrees for the columellar strut graft group
compared with 1.9 degrees for the septal exten-
sion graft group (P < 0.0001). Rotation loss was
also significantly greater in men compared with
women (5.0 degrees versus 2.9 degrees; P < 0.05)
on unadjusted analysis. Performance of alar base
resection approached but did not reach statistical
significance for rotation loss (3.6 degrees versus
2.7 degrees; P = 0.141). The type of rhinoplasty
performed was also associated with long-term
rotational changes on univariate analysis. Neutral
rotation rhinoplasty had minimal long-term
change (0.8 degree), whereas both positive and
negative intraoperative rotational changes were
associated with long-term rotation loss greater
than 3 degrees (Tables 4 and 5) (P < 0.002). All
other evaluated demographic and surgical factors
were not significantly associated with rotation loss.
Multivariable logistic regression results of
clinically significant rotation loss (defined as
≥5 degrees loss) are shown in Table 6. After

Table 4. Rotation Loss (Unadjusted) (N = 77)

Mean Rotation Loss Mean Rotation Loss
No. Degrees No. Degrees P
Demographics
 Race White (n = 52) 2.9 Nonwhite (n = 25) 3.8 0.875
 Sex Male (n = 11) 5.0 Female (n = 66) 2.9 0.028a
Intraoperative factors
 Crural transection Yes (n = 7) 1.6 No (n = 70) 3.3° 0.894
 Alar base resection Yes (n = 38) 3.6 No (n = 39) 2.7° 0.141
 Graft type SEG (n = 37) 1.3 CS (n = 40) 4.9 <0.0001a
SEG, septal extension graft; CS, columellar strut graft.
a
Statistical significance of at least P < 0.05.

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 Volume 152, Number 2 • Superiority of Septal Extension Grafts

Table 5. Rhinoplasty Type Classification (Unadjusted)a modifications to the caudal septal extension graft
Mean Loss were separately described by Byrd et al.5 and by
No. Degrees P Toriumi6 as more stable alternatives to the colu-
Intraoperative rotation type <0.002
mellar strut graft.
Both columellar strut grafts and septal exten-
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 Neutral 35 0.8
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 Derotation 4 3.7 sion grafts serve as workhorse tip support grafts

 Rotation 38 3.3 in rhinoplasty. Their strength as a central post
a
Intraoperative rotation-type classification according to threshold of on which the tip elements are secured serves two
±5 degrees from preoperative to early postoperative period. purposes: (1) control of tip shape and position
and (2) stability of the tip elements over time.
Table 6. Multivariable Logistic Regression Proponents of the columellar strut cite its suf-
ficiency to preserve tip support while maintain-
95% CI
ing a soft tip, whereas proponents of the septal
RR Lower Upper P
extension graft claim superiority of stability and
Significant projection loss a
improved effectiveness when significant control
 Septal extension graft Ref — — — of tip position is desired.2,3,5,6,10 Because both
 Columellar strut 5.13 1.64 16.0 <0.005b
grafts are otherwise quite comparable in terms
 Male sex 1.83 1.03 3.26 <0.05b
of the logistics of their use, determination of
 Neutral-projection Ref — — —
rhinoplasty which to use has largely been based on surgeon
 Deprojection 0.57 0.25 1.31 0.184 preference. More recently, direct comparison of
rhinoplasty the two grafts with regard to longevity of tip sup-
 Projection rhinoplasty 1.10 0.41 2.98 0.845 port has been published by Sawh-Martinez et al.8
Significant rotation lossc They retrospectively analyzed three-dimensional
 Septal extension graft Ref — — — photographs (Vectra) in 106 primary rhinoplasty
 Columellar strut 2.79 1.16 6.72 <0.05b
patients. Projection and rotation were compared
 Male sex 0.87 0.41 1.78 0.677
between the early postoperative period (6 weeks)
 Neutral-rotation Ref — — —
­rhinoplasty and late postoperative period (1 year). They were
 Derotation rhinoplasty d d d
— able to identify a significant improvement in
 Rotation rhinoplasty 2.53 1.08 5.94 <0.05a maintenance of tip rotation but were unable to
RR, relative risk; Ref, reference. demonstrate any significant difference in tip pro-
a
Significant projection loss defined as >4% projection loss. jection over time.
b
Statistical significance of at least P < 0.05.
c
Significant rotation loss defined as ≥5-degree loss. We sought to explore this debate further. The
d
Insufficient observations. senior author primarily used the columellar strut
until the middle of 2018, when he made a sum-
adjusting for patient sex and rhinoplasty rotation mary switch to the use of a fixed-floating septal
type, the independent effect of columellar strut extension graft, in which the graft is secured abut-
use resulted in a 2.79-fold increased risk of clini- ting the caudal septum unilaterally and floats
cally significant rotation loss compared with the above the anterior nasal spine. This provided
use of a septal extension graft (95% CI, 1.16 to a unique opportunity to evaluate the impact of
6.72; P < 0.05). Male sex was not independently graft use while holding all other variables con-
associated with decreased rotation loss after stant. Importantly, this also allowed retrospective
adjusting for graft type. Larger intraoperative graft evaluation without the selection bias intro-
rotational changes were associated with greater duced by using dynamic clinical criteria to dictate
rotation loss long term, independent of graft type graft selection.
used (relative risk, 2.53; P < 0.05). In this study, we again demonstrated the long-
held observation that rhinoplasty patients tend to
lose some degree of projection and rotation over
DISCUSSION time. However, the columellar strut and septal
Restoring support of the tip after open rhi- extension grafts are not equivalent in their abil-
noplasty is an essential component of consistent ity to maintain tip position over time. Specifically,
and stable rhinoplasty. Several methods of tip we found that the maintenance of both projec-
support have been described. Historically, colu- tion and rotation was improved in the septal
mellar strut grafts have been workhorse grafts for extension graft group compared with the colu-
lower limb support during open rhinoplasty.4,10 In mellar strut graft group. Proponents of the sep-
the 1990s, the caudal septal extension graft and tal extension graft have long held that the septal

337
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 Plastic and Reconstructive Surgery • August 2023
extension graft provides a “put it where you want
it” approach to tip shaping2,5–7,11 compared with
alternative methods. With an average projection
loss of only 0.2% and rotation loss of 1.9 degrees
when using a septal extension graft, our findings
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further support that claim.
We found that male sex was also indepen-
dently associated with greater loss of projec-
tion over time compared with women. In fact,
nearly 90% of men who underwent columellar
strut graft surgery had greater than 4% projec-
tion loss (which translates to approximately
>1.5 mm). Rotation loss, however, appeared to
be more dependent on graft-type selection than
on patient sex, with no significant difference
between men and women after adjusting for graft
type. The observation of greater projection loss
in men is likely explained by the thicker skin
and greater overall forces exerted on the skeletal
framework of the male nose, whereas the rela-
tively stable rotation differences between men
and women may be a result of the more modest
nasolabial angles used on the male nose. This is
conjecture, however, as this study was not primar-
ily designed to evaluate this subgroup, and thus,
more directed studies are needed to elucidate
this observation. However, we may surmise that
emphasis on providing strong tip support and/or
slight overcorrection of tip position is even more
important in the male patient.
The senior author transitioned from primarily
using the columellar strut for tip support to pri-
marily using the septal extension graft. Because
this was a summary change in technique in a
single-surgeon cohort of patients, this provided
a unique opportunity to compare these two graft
techniques head to head without the selection
bias that often accompanies such retrospective
comparisons. In addition, this study is the only to
perform a multivariable logistic regression analy-
sis of projection and rotation outcomes related to
graft selection, further quantifying the impact of
graft selection on tip stability. The impact of graft
selection appears to be even more important in
male patients, who saw the greatest loss in tip pro-
jection when a columellar strut graft was used.
This study was limited by its retrospective
nature, although we attempted to minimize
study bias in our design. By using consecutive
patients centered temporally on a summary
shift in graft technique, we mitigated selec-
tion bias; in addition, the temporal limitation
of a retrospective study was not relevant here,
given the nature of the exposure and outcome.
This study used professional two-dimensional
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Copyright © 2023 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
photography to make all measured compari-
sons. Although not used here, three-dimen-
sional stereophotogrammetry using Vectra or
similar technology has been described in a
similar study8 and provides certain precision
benefits12,13 when measuring absolute values.
However, by using relative measurements as we
do here, we have accounted for measurement
variability/randomness inherent in manual
measurement and minimized their effect on
study outcome measures.
CONCLUSIONS
Septal extension grafts result in effectively
no loss of projection and minimal rotation loss
long term, allowing the surgeon to intraopera-
tively place the nose where desired. When using
a columellar strut graft alone, a small degree
of projection loss can be expected. These long-
term graft tendencies should be anticipated and
accounted for appropriately during rhinoplasty.
In our practice, columellar strut grafts have
been relegated to an adjunct graft role, being
used as a smaller, floating graft in addition to
a septal extension graft in select patients who
are otherwise at-risk for columellar retraction or
deformity.
In this article, we present our series, and along
with that of Sawh-Martinez et al., this remains one
of the first to compare these two grafts head to
head. We strongly encourage other authors with
significant rhinoplasty experience to do the same
to further our understanding of long-term tip
dynamics with different techniques.
Rod J. Rohrich, MD
Dallas Plastic Surgery Institute
9101 North Central Expressway, Suite 600
Dallas, TX 75231
rod.rohrich@dpsi.org
DISCLOSURE
Dr. Rohrich receives instrument royalties from Eriem
Surgical, Inc., and book royalties from Thieme Medical
Publishing; he is a clinical and research study expert for
Allergan, Inc., Galderma, and MTF Biologics, and the
owner of Medical Seminars of Texas, LLC. Dr. Bellamy
has no financial disclosures to report. No funding was
received for this article.
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