Aesthetic Plastic Surgery

, Volume 43, Issue 1, pp 202–205 | Cite as

“Dual-Knot Fixation” Technique for Better Stabilization of the Extended Columellar Strut Graft with the Anterior Nasal Spine

  • Aret Çerçi Özkan
Innovated Techniques Rhinoplasty



Extended columellar strut graft (ecsg.) is one of the most crucial cartilage tissues used especially in secondary rhinoplasties. Stabilization of an ecsg. with the anterior nasal spine (ans.) is very important. Regular suture placement is the most common practice. Nevertheless, this kind of suture fixation may result in sliding of the ecsg. through either side of the ans. Suture placement like the figure of eight may prevent sliding of the ecsg. to sides. However, the figure of eight suture forces the graft to turn around during its fixation.


I have tried to solve these two problems with a simple still better suture technique. After passing the suture through the hole of the ans., a stabilization knot is tied over the spine tip. Then passing the suture through the lower end of the ecsg. and fixating it with a second knot named as the “fixation knot” results in very good stabilization and prevents both side sliding and rotation of the graft. This stabilization technique can be called “dual-knot fixation” (dkf.). Opening a small notch at the lower tip of the graft may help to hide the “stabilization knot” inside the graft which will help to obscure the tiny space between the cartilage and the bone, and thus the bonding process between the graft and spine would be better.

Level of Evidence V

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Rhinoplasty Knot Secondary Graft Fixation 


Compliance with Ethical Standards

Conflict of interest

The author declares that he has no conflict of interest.


  1. 1.
    Toriumi DM, DeRosa J, Watson D (2014) Structural grafting in secondary rhinoplasty. In: Rochrich RJ, Adams WP, Ahmad J, Gunter JP (eds) Dallas rhinoplasty, 3rd edn. QMP&CRC Press, Florida, pp 878–880Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2018

Authors and Affiliations

  1. 1.IstanbulTurkey

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