Recycling the distal dorsum as a sheen graft

Abstract

Background: Surgeons performing rhinoplasty are increasingly faced with secondary procedures in graft-depleted patients. Objective: A method is described for recycling resected distal dorsum as a Sheen tip graft. Methods: Each of 16 primary rhinoplasty patients was treated with a Sheen graft to the nasal tip harvested from the distal cartilaginous dorsum; the dorsal cartilaginous hump was removed without dorsal mucosal disruption. Intact dorsal vestibular mucosa acts as a mucosal spreader graft by adding width between the dorsum and the resected upper lateral cartilages. The hump must be large enough that resection of the distal dorsum will not result in overresection of the midvault. Results: Postoperative photographic analysis of each of the 16 patients after 1 to 5 years of follow-up shows increased nasal tip projection, establishment of a tip-defining point, and a double break (a supratip and infralobular break). No graft absorption was clinically noted. Conclusions: Recycling of the distal dorsum as a Sheen graft in selected patients results in an aesthetic contour. This method limits surgical dissection to a single donor area, saves time, preserves the septum, avoids potential septal perforation or hematoma, and decreases hemorrhage and edema.