Tip Plasty Research Articles

M-Shaped Auricular Cartilage as Modified Septal Extension Graft: A Study by Three-Dimensional Anthropometric Analysis in Asian Rhinoplasty.

The septal extension graft is one of the most commonly used grafts in Asian tip plasty techniques. However, the septal extension graft usually induces a hard and immobile nasal tip. The purpose of this study was to evaluate the esthetic outcomes of the modified septal extension graft with M-shaped auricular cartilage by three-dimensional anthropometric analysis. A total of 36 patients received augmentation rhinoplasty with M-shaped auricular cartilage as septal extension graft combined with silicone implant. Thirteen measurement items were evaluated using three-dimensional anthropometric techniques, and the preoperative and postoperative results were compared. The majority of patients (91.7%) were satisfied with the postoperative nasal shape. No infection, gross absorption, graft exposure, implant exposure, or implant migration was observed. Compared with the preoperative value, the nasal length, nasal height, nasal depth, nasion height, columella width, nasolabial angle, nasofrontal angle, and nasal depth-nasal width index significantly increased. The nasal width, nasal tip width, and nasal index significantly decreased. We performed tip plasty with the M-shaped auricular cartilage as modified septal extension graft, achieving a soft and mobile tip with satisfying tip projection in most patients. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Experience With Autologous Nasal Septum Cartilage Combined With Conchal Cartilage in Nasal Tip Reconstruction.

There has been an increase in use of autologous costal cartilage for nasal tip shaping material. However, there are deficiencies in using this plastic material, such as a hard nasal tip, poor nasal tip elasticity and mobility postoperatively, and some nasal tip skin thinning that allows the shape of the cartilage grafts to be felt on the surface of the nasal tip skin. To address these problems, we have combined autologous nasal septum cartilage and conchal cartilage as nasal tip graft materials, which achieve a natural shape and realistic touch postoperatively. From January 2017 to September 2019, a total of 47 patients with nasal septal cartilage combined with conchal cartilage transplantation for nasal tip plasty were screened for a retrospective study. They were followed up and evaluated for 6 to 25 months postoperatively. The operation was performed through an incision in the nose. During the operation, a piece of septal cartilage was cut to make a columella strut. Using one side of the cavitas conchae and cymba conchae cartilage as the graft material, 2 long strips of cartilage were excised for the septum extension graft, and a piece of cap cartilage was transplanted to the top of the nasal tip cartilage scaffold. The time between the operation and follow-up was greater than 6 months, with the range of follow-up and evaluation being from 6 to 25 months. Forty-six patients were satisfied with the shape of the nose. One patient complained that the nasal tip was round and large after 1 month postoperatively, but after 6 months, he was satisfied with the shape of the nasal tip after daily use of a nasal clip. In one male case, the implant was removed more than 7 months postoperatively because of hematoma and infection secondary to nasal trauma. There were 2 cases of nasal tip numbness, both of which recovered spontaneously after 12 months. After the operation, the shape of the nasal tip was round, no cartilage contour was seen on the surface, no collapse of upper nasal tip, no obvious deviation of the nasal dorsum and columella, and no deformation and displacement of the nasal tip cartilage scaffold. At the 6-month follow-up visit, each patient palpated the nasal tip for evaluation. Most patients felt their nose felt realistic and that they had good nasal tip motion. Only 1 patient felt that the nasal tip and the nasal dorsum were moving together when the tip of the nose was being pushed. Nasal septum cartilage and conchal cartilage can be combined as a graft material for reconstruction of the nasal tip. This technique uses different characteristics of each of the 2 cartilages to achieve a more realistic and esthetic outcome.

Optimal harvest and efficient use of septal cartilage in rhinoplasty.

BackgroundNasal septal cartilage is used to obtain favorable aesthetic and functional outcomes in rhinoplasty, but is often difficult to harvest or the harvested amount is insufficient. Therefore, the objective of this study is to introduce how to harvest septal cartilage optimally without losing and use harvested cartilage efficiently.MethodsFrom March 2015 to January 2020, we tried to harvest as much septal cartilage as possible while maintaining the L-strut in 30 patients. A spreader flap and septal rotation suture were used instead of a spreader graft. Also in patients who needed a spreader graft and septal extension graft, a spreader graft was used on one side and a one-piece spreader graft combined with a septal extension graft was performed on the other side. For tip plasty, a columella septal suture was performed first. Postoperative patient satisfaction was assessed using the Rhinoplasty Outcome Examination questionnaire.ResultsNo serious complications were observed. The patient satisfaction score was 50% or above in 27 patients (90%) and less than 50% in only three patients (10%). The average score was 81.5 points.ConclusionFor septal cartilage deficiency, a spreader flap, the septal rotation suture, or one-piece spreader graft combined with a septal extension graft was used. The nasal tip was sufficiently rotated using the columellar septal suture technique first. These techniques made it possible to obtain good aesthetic outcomes using only septal cartilage, without harvesting other cartilage.

Biomechanical Nasal Anatomy Applied to Open Preservation Rhinoplasty

Preservation rhinoplasty is a new way to reshape the nose by preserving the dorsum, nasal ligaments, soft tissue envelope, and muscles. This new concept provides the opportunity to achieve a more natural aesthetic and functional result. To achieve a good aesthetic and functional outcome while maintaining surgical safety, knowledge of the relevant anatomy is key. This is especially true for the preservation rhinoplasty technique, where a firm grasp of the anatomy of the nasal soft tissue and bony-cartilaginous framework is critical. The preservation technique is made more accessible by the open approach, which provides an opportunity for the deformity to be clearly visualized from the tip of the nose and the dorsum. Furthermore, tip plasty is easier to perform under direct vision, which is an advantage of the open approach. The goal of this article is therefore to make clear all the important anatomical structures and their relevance to the surgical steps taken when performing the open preservation rhinoplasty technique.

A Comparative Study Between Classic Derotation Graft and Novel Double V Cutting Folded Derotation Graft

To introduce an innovative refinement, the "double V cutting folded derotation graft" (DVCFD graft), which is a method for nasal tip lengthening in aesthetic rhinoplasty with strong holding force and efficient cartilage use. A retrospective study was conducted from January 2018 to July 2019 with 101 patients, including 11 males and 90 females with an average age of 36.87 ± 10.12 years, at Chang Gung Memorial Hospital; the patients received classic derotation grafts (n = 49, 17 of them were one layer and 32 of them were two layers) and DVCFD grafts (n = 52) for cosmetic tip plasty. The tip projection, columella labial angle and nasolabial angle were measured through clinical photography at three different times (T0: pre-operation, T1: two weeks post-operation and T2: five months post-operation). The differences between the original derotation graft and the DVCFD graft were identified using paired-t and independent-t tests. The final relapse ratios of the classic derotation graft and DVCFD graft were 36.78% versus 36.92% for tip projection, 40.65% versus 38.58% for columella labial angle and 45.00% versus 47.76% for nasal labial angle, respectively. The P values of the independent-t tests were 0.991, 0.564 and 0.439, respectively. Both the classic derotation graft and DVCFD graft possess similar stability in tip plasty. The novel modification of the DVCFD graft has more efficient cartilage usage and is a feasible and safe surgical option for patients with limited harvestable cartilage for tip lengthening. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Application of Conchal Cartilage Grafts in Nasal Tip Plasty: Comparison and Experience of 3 Methods.

The autologous conchal cartilage of good elasticity is easy to harvest, thus is often used in nasal tip plasty of East Asians. However, the operation techniques vary a lot among different surgeons. This article aims to introduce 3 techniques commonly used in clinical practice. One hundred three patients were included in this study and divided into 3 groups according to the shape of the nasal tip during 2017 to 2019. The patients were followed up for at least 6 months. All patients were measured with Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). ImageJ software was used to measure and calculate the projection ratio for lateral position standard image, and columella-labial angle (CLA) was measured. In group 1, SCHNOS for nasal obstruction (SCHNOS-O) score were 13.23 ± 7.61 and 14.49 ± 10.55 (P > 0.05); SCHNOS for nasal cosmesis (SCHNOS-C) score were 66.55 ± 31.23 and 21.73 ± 18.91 (P < 0.001); projection ratio were 0.51 ± 0.04 and 0.57 ± 0.05 (P < 0.001); CLA were 91.02° ± 5.67° and 93.55° ± 4.64° (P > 0.05), preoperative and postoperative, respectively. In group 2, SCHNOS-O score were 16.76 ± 13.44 and 15.44 ± 9.26 (P > 0.05); SCHNOS-C score were 61.87 ± 44.14 and 19.16 ± 29.37 (P < 0.001); projection ratio were 0.50 ± 0.05 and 0.58 ± 0.03 (P < 0.001); CLA were 92.32° ± 6.39° and 94.86° ± 5.96°(P > 0.05), preoperative and postoperative, respectively. In group 3, SCHNOS-O score were 15.25 ± 7.83 and 17.73 ± 11.66 (P > 0.05); SCHNOS-C score were 52.03 ± 33.38 and 17.73 ± 11.66 (P < 0.001); projection ratio were 0.53 ± 0.05 and 0.57 ± 0.02 (P < 0.001); CLA were 91.65° ± 5.75° and 93.21° ± 5.38° (P > 0.05), preoperational and postoperational, respectively. None of these 3 techniques cause or aggravate nasal obstruction, and all of them can achieve high cosmetic satisfaction. Technique 1 and technique 2 are suitable for the patients with moderate and moderate to severe short nose that is common in East Asia, which can better increase the protrusion of the tip and length of the nose. Technique 3 is suitable for the patients with better shape of the nose, who need to slightly increase the protrusion of the nasal tip and increase the upward rotation.

Correction of secondary unilateral cleft lip nasal deformity in adults using lower lateral cartilage repositioning, columellar strut, and onlay cartilage graft on the nasal tip with open rhinoplasty combined with reverse-U incision

A rhinoplasty technique involving lower lateral cartilage (LLC) repositioning and grafting of ear cartilage allows for nasal lengthening and nasal tip mobility. For better esthetic outcomes in patients with cleft lip nasal deformity (CLND), we combined cosmetic nasal tip plasty with standard techniques. We performed open rhinoplasty combined with reverse-U incision and V-Y plasty in 62 patients with secondary unilateral CLND from October 2013 to June 2018. Both LLCs were isolated, repositioned, approximated medially, and advanced with a Medpor strut, followed by tip suture technique. To further project and enhance the nasal tip and columella, application of ear cartilage onlay graft was used. As adjunctive procedures, septoplasty or osteotomy was carried out for correction of septal or nasal bone deviations, respectively. Photogrammetric evaluations of patients and statistical analyses were performed. Average age at operation was 23.5 years (range: 18-42 years). Of the 62 patients, 15 underwent dorsal augmentation with silicone implant. Two-layer conchal cartilage onlay grafting was performed to manage tip height. Outcomes in 34 patients were analyzed with pre- and postoperative photography. Nasal tip projection increased, alar base width index decreased, and alar and columellar symmetry significantly improved. No Medpor implant exposure or other adverse outcomes occurred. The proposed technique is effective for correcting secondary unilateral CLND and achieving a satisfying nasal appearance in adults.

A new technique in Asian nasal tip plasty: Non-incisional double-layered conchal cartilage graft

The columellar strut graft based on the use of back-to-back autogenous conchal cartilage is one of the most commonly employed invisible grafts used for nasal tip projection. This graft provides an effective means of achieving nasal tip projection but is limited by its flexibility, especially with respect to cephalic rotation. We designed an effective technique that addresses these limitations. A total of 38 patients received augmentation rhinoplasty with non-incisionally bent double-layered conchal cartilage columellar strut graft with nasal tip onlay graft. Projection and location of the nasal tip, nasal length, and nasolabial angle were measured using lateral view photographs. Pre- and postoperative results were compared. Pre- and postoperative nasal tip projection ratios and nasal tip location ratios were significantly different. Revision surgery was not required in any case and no direct graft-associated complication occurred. We performed tip plasty with a modified columellar strut graft, that is, a non-incisionally bent double-layered conchal cartilage columellar strut graft. In most cases, this method resulted in a significant tip projection increase.

Comma-Shaped Columellar Strut for Nasal Tip Plasty in East Asian Rhinoplasty.

For East Asians, rhinoplasty procedures are predominantly focused on reconstructing a well-defined nasal tip. In this study, the authors present a new graft design for the columellar strut that is similar to the shape of a comma mark. As one integrated piece, the graft undertakes the roles of providing solid support for the tip, modifying different angles, as well as relationships between the tip and columella. One hundredand sixty-five female patients, ranging in age from 18 to 42years (average 27.1years), received augmentation rhinoplasty surgery over the past 4years with an average postoperative follow-up of 12months. Among these patients, 78 of them were primary cases and others were secondary or more. The cartilaginous framework was reconstructed based on comma strut with other grafts including spreaders and dorsal onlay grafts. Patients' own evaluations on the overall improvements of the nose rendered high satisfaction rate. During the long-term follow-up, 8 cases presented asymmetrical nostrils with slightly deviated columella; minor revision surgeries were performed. Another 3 cases presented dorsal graft warping and were also corrected. No other major complications were encountered. The comma strut provides a reliable support for the nasal tip; its dual curved structure plays the instrumental role in defining the lobular-columellar angle as well as modifying the supratip break. This graft design offers good control of tip and columella; as a result, consistent, reproducible results can be achieved. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The miniature lateral crural strut graft: Efficacy of a novel technique in tip plasty

To describe a novel technique for tip plasty and determine its efficacy using validated patient-reported outcome measures and objective measures. Retrospective cohort study. This study was carried out at a tertiary center. Patients undergoing tip plasty using the miniature lateral crural strut grafts (mini-LCSG) in cosmetic/combined rhinoplasty between January 2016 and August 2019 with available outcome measures were included. We used the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS), Nasal Obstruction Symptom Evaluation (NOSE) scores, visual analog scale: functional and cosmetic, and lateral wall insufficiency (LWI) grades. Among 52 patients, 33 were included; 26 had cosmetic whereas seven had combined functional and cosmetic rhinoplasty, with a follow-up up to 3 years. Both cosmetic and combined subjects showed significant improvement in SCHNOS-Cosmesis (C) scores (-57.31 ± 1.79, P < .001 and - 53.57 ± 8.39, P < .001, respectively) and zone 1 LWI (P < .05, both sides). SCHNOS-Obstruction (O) and NOSE scores showed significant decrease among subjects undergoing combined rhinoplasty only (-55.36 ± 18.58, P < .004, and - 53.93 ± 15.99, P < .003, respectively). With specific regard to tip cosmesis, the mean SCHNOS-6 (item 6 of the SCHNOS questionnaire for tip cosmesis) showed significant improvement (-2.61, P < .001). The mini-LCSG is a novel modification for tip plasty that improves tip cosmesis and symmetry, both subjectively and objectively without compromising nasal function. 4 Laryngoscope, 130:2581-2588, 2020.

Modified Cartilage Sparing Tip Plasty Technique for Extra Projection: Hemitransdomal Suture With Submucosal Dissection: A New Approach to Nasal Tip Dynamics.

The nasal tip projection and rotation to be obtained with tip plasty play a key role in achieving successful results. Cartilage sparing techniques provide extra ease to reshape the cartilage in revision rhinoplasty. Freed dome cartilage eliminates the restricting forces of mucosa. The authors recommend to free the dome cartilage from mucosa during the tip plasty which ensures the desired dome shape and extra projection. A total of 218 patients who were operated between the dates of January 2017 and August 2018 were included in this study. About 3 mm parts of the marked domes toward medial and lateral crurae were dissected from the mucosa. New domes were created with bilateral hemitransdomal sutures. The outcome of the operation was asked to the patients verbally and answers were recorded. Of 218 patients who were included in the study, 182 were females and 36 were males. Patients had a mean age of 26.5 years. The length of follow-up was 11.8 months. About 205 patients had primary rhinoplasty while 12 patients had secondary rhinoplasty and 1 patient had revision rhinoplasty. Of the patients, 89.9% (196/218) were very satisfied with the result and 7.4% (16/218) were satisfied, whereas 2.7% (6/218) were dissatisfied. Only 5 patients who were dissatisfied with the result underwent revision rhinoplasty operation. The combination of the modified free dome suture with the mucosal dissection in dome area provides achieving the desired tip projection and symmetry.

Surgical outcomes and complications of septal extension graft supported by 3D printed polycaprolactone plate.

Tip plasty using a septal extension graft (SEG) is useful in the Asian population. However, complications such as decreased tip projection, infection, or deviation are noted post-surgery, and additional support using an SEG is often necessary. We aimed to transplant an additional 3D printed polycaprolactone (PCL) graft to the tip plasty using the SEG to reinforce the SEG. The study included 43 patients (20 males and 23 females; mean age, 28.7 years; range, 17-58 years) who received rhinoplasties using the SEG method combined with a 3D printed PCL graft from November 2016 to August 2017. The mean observation period was 14.8 months (range, 12-20 months). Twenty-six patients rated their satisfaction level as excellent, 13 rated good, 3 rated fair, and 1 rated poor. In total, 28 patients did not exhibit tip drooping at the 1-year follow-up; 13 patients demonstrated mild to moderate tip drooping, and 2 patients demonstrated severe tip drooping. Thirty-one patients demonstrated "stiffness" of the nasal tip, of which 11 patients reported discomfort, and 20 patients reported none; two patients demonstrated deviation of the tip. Although the 3D-printed PCL graft provided support, biocompatibility, and manipulability, care is required to prevent complications. 4 Laryngoscope, 130:1680-1685, 2020.

New Technique in Nasal Tip Plasty: Sandwich Technique Using Cartilage and Septal Bone Complex.

It is extremely difficult to obtain ideal tip projection and nose lengthening by septal extension graft using only septal cartilage in Asians, because their nasal septal and alar cartilages are small and weak. Therefore, we introduce a new septal extension graft using a cartilage-bone complex with the vomer and the perpendicular plate of the ethmoid bone as well as cartilage to obtain optimal outcomes. Participants included 30 patients who underwent surgery by external approach. The septal cartilage, vomer, and perpendicular plate of the ethmoid bone harvested by septoplasty were used. There were 2 layers of cartilage on each side and bone in between to create a strong cartilage-bone complex for projection and lengthening. The bony portion was placed in the tip side, and the double-layered cartilage portion was placed in the inferior portion of the caudal septum of the L-strut to create powerful fixation. There were statistically significant improvements in nasal length (4.71 ± 0.65 vs 5.15 ± 0.53 cm, P value <.0001), tip projection (2.66 ± 0.40 vs 3.18 ± 0.42, P value <.0001), and nasolabial angle (94.0° ± 9.3° vs 107.2° ± 9.6°, P value <.0001) postoperatively. All patients were subjectively satisfied, and 2 different surgeons had excellent or good opinions in 28 (94%) patients. The sandwich technique using cartilage and bone complex results in satisfactory outcomes with stronger tip support, especially in Asians with a weak nasal tip who desire ideal tip projection and dramatic change.

Nasal tip plasty using three-dimensional printed polycaprolactone (Smart Ball®).

BackgroundRhinoplasty is one of the most commonly performed cosmetic surgery procedures. Most Asians desire elevation of their relatively flat nasal dorsum and tip to make them appear more prominent. This study introduces a simple method of nasal tip plasty using three-dimensional (3D)-printed polycaprolactone (PCL) (Smart Ball®), which provides the required length and volume for this purpose and enables the creation of a nasal tip of the desired shape in a safe and simple manner.MethodsBetween September 2014 and May 2017, 22 patients participated in a survey to assess postoperative satisfaction levels. Additionally, three plastic surgeons compared patients’ pre- and 1-year postoperative photographs to evaluate the results. All patients underwent 2- to 4-year postoperative follow-up.ResultsLevels of subjective satisfaction among patients were 3.59, 3.50, 3.82, 3.73, 3.55, and 3.82 for each of the 6 categories evaluated, with a mean of 3.67/4 points, indicating high satisfaction levels. The mean plastic surgeon-reported score for the 22 patients was 4.47/5 points, which also indicates highly successful outcomes. Postoperative nasal tip rotation and tip projection were ideal in most patients.ConclusionOur novel method using 3D-printed PCL (Smart Ball®) provides the optimal length and volume required for nasal tip plasty and enables the creation of a nasal tip of the desired shape, in a safe and simple manner. An advantage of our method is that it retains the original nasal structure in contrast to structural changes observed with the use of conventional methods.

Autologous costal cartilage for nasal tip surgery: report of 86 cases

Objective To present our experience and techniques with the use of autologous costal cartilage grafts in Asian rhinoplasty, and to report the surgical results and complications in 86 consecutive rhinoplasty cases. Methods All operations were performed by the first author (Liu AT) with open approach, costal cartilages and perichondrium were used to reconstruct the nasal tip projection according to the tripod theory in rhinoplasty, after removing the previous injection material, L-shaped implant or hypertrophic scar tissue in the tip. Medical charts and operative records were reviewed retrospectively to summary the complications. Nasal dorsum augmentation was done by costal cartilage or I-shaped allograft, sometimes with anterior sheath of rectus abdominis. Patients＇ subjective satisfaction of the postoperative nasal appearance was self-evaluated with grading (1 worse, 2 no change, 3 improved, and 4 much improved). Results From September 2015 to March 2017, 86 patients underwent rhinoplasty at our hospital. The postoperative follow-up duration was 6 to 20 months. Overall, functional and aesthetic outcome was satisfactory in most patients, and the mean score by the patients＇ self-evaluation was 3.3±0.6. Graft exposure, mobility, or significant resorption, pneumothorax or significant donor-site pain were not observed. Conclusions Even with minimal complications and morbidities, autologous costal cartilage grafts in Asian rhinoplasty is a versatile and reliable graft material for nasal tip surgery in severe short or saddle nose, contracted nose due to previous L-shaped augmentation and revision rhinoplasty in which the septal cartilage has already been harvested. Key words: Autologous costal cartilage; Nasal tip plasty; Nasal dorsum augmentation; Revision rhinoplasty; Saddle nose

Vertical Alar Folding (VAF): A Useful Technique for Correction of Long and Concave Lateral Crura in Rhinoplasty.

The tripod theory explains the dynamics of the nasal tip, where surgery is difficult because of anatomic variations and pathologies and the various surgical possibilities. Abnormalities or weaknesses of the lateral crura can result in concavity in ala or alar collapse and cause aesthetic and functional impairments of the nose. Several tip plasty techniques and lateral crura modifications are used in rhinoplasty. To describe the vertical alar folding (VAF) technique for making modifications in the lateral crura (LC) and rotation of the tip. Included in the study were 83 patients (59 women, 24 men) undergoing rhinoplasty using VAF with the senior author as surgeon between 2013 and 2018. The mean age was 26.3years (range 18-47). Mean postoperative follow-up period was 26.7months (range 12-64). Patients who completed the 1-year postoperative period completed the rhinoplasty outcome evaluation (ROE) questionnaire. Outcome measures were performed at examinations, and preoperative and postoperative photographs of the patients were analyzed. In the span of 5years, no revision surgery was required for technique-specific reasons. In patients who had a droopy or asymmetric tip or long and concave lateral crura, we saw remarkable functional and aesthetic improvements with VAF. According to the ROE questionnaire, 90.3% (75 out of 83) of the patients were content with the aesthetic and functional results. VAF is a useful and effective method for modifying the LC and tip of the nose. VAF allowed for controlling the rotation and projection of the tip, changing the length of the lateral crus and nose with durability and smooth, symmetric contours, and correcting concavity of a lateral crus for better functioning and aesthetics. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Classification pattern and step-by-step procedure for cartilage grafts with silicone implants for nasal tip plasty in Asians

Dorsal augmentation using silicone and tip plasty with autogenous cartilage is commonly performed in Asians. No study has investigated the classification pattern and step-by-step procedure for tip plasty using silicone implants. Therefore, this study classified cartilage grafts using silicone implants in Asians and developed a step-by-step procedure for their implementation. The study included 39 patients who had undergone augmentation rhinoplasty with a silicone implant combined with a conchal cartilage graft as a shield, an onlay graft, or both. We classified the implant-conchal cartilage complex into two main types (edge and no-edge types). In the edge type, the shield graft tip was located 1-2mm above the silicone implant or onlay graft. In the no-edge type, it was located at the same level as the silicone implant or onlay graft. Each type was classified into three groups depending on the number of onlay grafts: group I, 0; group II, 1; and group III, ≥2. The cartilage complex was placed on the dorsum. The conchal cartilages were harvested through a post-auricular incision while preserving the radix helicis as cartilage bars. The donor site was closed primarily without a tie-over dressing. Of the 39 patients, 35 were satisfied with the outcome. Three revision operations for implant displacement and one revision for a patient who changed her dorsal height preference were performed. No donor site morbidity occurred. This method may be safe and reliable, with minimal morbidity associated with graft harvesting for tip plasty in Asians.

Tip Reinforcement Flap: An Original Technique for Improving Nasal Tip Support and Definition.

Middle crura support deficiency and short middle crura can usually cause insufficient definition and projection of the tip and can sometimes result in a flat tip. The aim of this study was to investigate the effectiveness of a new technique involving a tip reinforcement flap to strengthen the middle crura and to achieve a well-projected and defined tip. Twenty-nine patients who underwent primary open-approach rhinoplasty that included the use of tip reinforcement flaps were included in the study. Cartilage flaps that had been created from the excess cephalic portion of the lateral crura were prepared as medial crura-based cartilaginous flaps. There were 29 patients (17 women, 12 men) aged 18 to 44 years (mean age, 31 years). Follow-up time ranged between 3 and 25 months (mean, 21 months). Preoperative and postoperative average of nasal tip length was 10.84 (±1.07) mm and 14.32 (±2.34) mm, respectively (P = 0.0214). Preoperative and postoperative average of nasolabial angle was 97.42° (±9.84°) and 107.99° (±12.16°), respectively (P = 0.0344). Preoperative and postoperative average of nasal projection ratio was 0.53 (±0.04) and 0.57 (±0.03), respectively (P = 0.4347). The tip reinforcement flap technique provided strengthening and extra support for the middle crura and increased definition, projection, and stability to the domal area. The tip reinforcement flap technique offers advantages for tip plasty in those cases with middle crural deficiency, short middle crura, and middle crural weakness. The technique also provides an additional projection, stabilization, and definition to the nasal tip while reducing lateral crural cephalic excess. This technique improves nostril-lobular disproportion and has the advantage of hiding extra support grafted into the folded flap. Complications such as graft visibility, malposition, and asymmetry, which may occur with the use of classic tip grafts, can be eliminated with the tip reinforcement flap technique.

Transcutaneous Suture Tip Plasty: The Technique and Outcomes.

Radical resections and invasive techniques have been mostly replaced with more conservative techniques. The aim of this study was to assess the objective and the subjective functional and aesthetic outcomes of transcutaneous suture tip plasty. A total of 20 patients were included in the study. Patients were treated with transcutaneous suture tip plasty. Functional results were assessed with pre- and postoperative 6-month Sino-Nasal Outcome Test (SNOT-22) and acoustic rhinometry. The pre- and postoperative 6-month mean values of first minimal cross-sectional area (MCA1), second minimal cross-sectional area (MCA2), the distance from the tip of the probe to the first minimal cross-sectional area, the distance from the tip of the probe to the second minimal cross sectional area, nasal volume 1, and nasal volume 2 were measured. Facial analysis was made with the Rhinobase software, designed for facial analysis. The mean pre- and postoperative SNOT-22 scores were 25.55 ± 6.64 and 15.70 ± 8.11, respectively (P < .05). The mean pre- and postoperative nasolabial angles were 82.26º ± 5.69º and 101.47º ± 7.70º, respectively (P < .05). The mean pre- and postoperative nasofrontal angles were 144.30º ± 3.81º and 138.25º ± 3.26º, respectively (P < .05). The mean pre- and postoperative nasal length was 54.22 ± 4.62 mm and 49.95 ± 2.75 mm, respectively (P < .05). The mean pre- and postoperative tip projection was 25.77 ± 3.64 mm and 28.40 ± 2.97 mm, respectively (P < .05). Only postoperative MCA2 values on the right and left side were significantly different from preoperative MCA2 values (P < .05). None of the remaining postoperative acoustic rhinometry scores significantly differed from preoperative scores. Two patients (10%) required revision at around 1 month after surgery due to suture loosening and breakage. Especially in the era of minimal invasive surgery, transcutaneous suspension tip plasty is promising, with rapid and reliable functional and cosmetic results. Further studies with longer follow-up durations are needed to assess the long-term outcomes of this technique.

Subnasal Lip Lifting in Aging Upper Lip: Combined Operation with Nasal Tip Plasty in Asians.

The objective of this study was to illustrate a novel technique for lifting of the aging upper lip with nasal tip plasty in Asians. With this procedure, a shortening of the philtrum, an increase of the vermilion, and a natural and nicer mouth can be obtained, with increase of the tip of the nose simultaneously. Thirty patients were the subjects of this study. Incisions were made bilaterally beginning at the alar fold, entering nostrils, and rising medially on the skin below the lower margin of the medial crura. Excess skin of the philtrum was eliminated in two separate pieces and the muscle was suspended to the base of the nose with interrupted stitches. All patients expressed a high degree of satisfaction. The average ratio between the L1 reference line and the height of the upper lip measurement preoperatively was 0.43 ± 0.05. This ratio was improved postoperatively to an average of 0.32 ± 0.05. The nasolabial angle was 91.31 ± 4.19 degrees before surgery and 105.62 ± 5.04 degrees after surgery. The angle of the upper lip was 48.97 ± 2.41 degrees before surgery and 38.21 ± 3.34 degrees after surgery. Lip lift is an effective tool for correcting a natural tendency of the upper lip to cover the upper teeth during aging. There is a dramatic improvement in the patient's facial aesthetic appearance during smiling and at rest. The authors strongly recommend this technique as part of the surgical procedure to achieve a youthful face. Therapeutic, V.