Structural Grafting in Rhinoplasty

Abstract

The need for structural grafting in rhinoplasty arises when the nasal skeletal framework is weakened, malpositioned, or both. This review will be limited to structural grafting of the cartilaginous nasal skeleton. Current techniques will be reviewed and a technique introduced that addresses the common deformity of a superiorly rotated and deprojected nasal tip complex while simultaneously correcting nasal valve collapse. This technique is referred to as the Dynamic Adjustable Rotational Tip (DART) technique. The operative technique of the DART, as well as the basic philosophy regarding the tensile nature of the cartilaginous nasal skeleton will be described.

Tip-Oriented Closed Rhinoplasty Built on Septocolumellar Suture and a New Caudal Septal Graft Technique

“…The septocolumellar suture, as its name implies, relies on the lower Tip-Oriented Closed Rhinoplasty lateral cartilages and the caudal part of the nasal septum; therefore, the inherent characteristics of the nasal septum such as its height, length, shape, and thickness (stability) gain particular importance. [4][5][6][7][8][9][10][11][12] Particularly, the caudal portion of the septal cartilage has a significant influence on the versatility of the septocolumellar suture and the final arrangement of the nasal tip. In the original article on septocolumellar suture in closed rhinoplasty, the septocolumellar suture had been suggested as a figure-of-8 suture if the septum is too short and a risk for columellar retraction is present.…”

25 Nasal Valves: Importance and Surgical Procedures

“…[37][38][39] Related techniques of structural grafting for airflow improvement are important in cases of loss of tip support and changes in nasal tissue resilience resulting from rhinoplasties or aging effects, [40][41][42][43] varying from septal extension grafts to total reconstruction of the alar cartilages with a partially split septal cartilage graft. In our hands, septal extension grafts stabilized with spreader grafts such as splints are most effective.…”

The Tripod Theory of Nasal Tip Support Revisited

“…Open rhinoplasty approaches, which are designed to preserve the "major" nasal tip supports (lower lateral cartilage strength, the scroll region [if no cephalic trim is performed], and the caudal septal attachment to the medial crural feet), often use multiple structural grafts, while closed approaches, which sacrifice more of the classically accepted supporting elements, often use less grafting. The caudal septum, which is often ignored in nasal tip support discussions, is increasingly being used to provide a rigid platform for the nasal tip with tongue-in-groove techniques, 3 dynamic adjustable rotational tip grafts, 4 or caudal septal extension grafts. 5 The following questions should be raised based on experimental and clinical evidence: (1) How significant are the other assumed nasal tip support mechanisms, and are they universally applicable in the population of patients seeking rhinoplasty?…”

“…This has been paired with a surgical emphasis on preservation, reconfiguration, and conservatism, with an increased appreciation for providing medial tip support using grafts, permanent suture techniques, and caudal septal interposition. [3][4][5] In light of these practice shifts, it seems remarkable that little has been done to further investigate the structural elements of the nasal tip, especially when considering the growing body of literature describing new surgical techniques for various races/ethnicities and nasal subtypes. When one takes a step back from conventional wisdom, it becomes clear that our thinking has radically changed, while our underlying theories have remained static.…”