One of the complications of rhinoplasty is the loss of tip projection after the procedure, especially in cases where the tip cartilages are week and the tip is mainly suported by a high nasal bridge or the hump. In these cases the columella is reinforced with a piece of cartilage harvested from the septum, the so called columellar strut. If this is not done, one could develop a fullness above the tip which is not desirable and the aesthetic results would be poor. Dr Rafizadeh performs the open rhinoplasty technique allowing him a high degre of precision in placing the columellar strut and sutures to modify  the shape on the nasal tip.