The Tripod Graft

Abstract

IMPORTANCE Nasal tip revision remains one of the most challenging surgical procedures for facial plastic surgeons to perform.OBJECTIVE To describe preoperative and postoperative findings related to nasal tip functional and aesthetic aspects following revision rhinoplasty using the "tripod" technique. DESIGN, SETTING, AND PARTICIPANTSA retrospective descriptive study was performed in patients who underwent revision rhinoplasty between 2007 and 2012 at a clinic in Bogota, Colombia. A preoperative diagnosis of nasal tip deformity was made on the basis of photographic records and compared with postoperative nasal tip findings in patients who required the tripod technique. Photographs were evaluated before and after surgery every month for the first 3 months, and after 6, 9, and 12 months postoperatively. MAIN OUTCOMES AND MEASURESNasal projection, tip rotation, columellar and alar retraction, alar pinch, lack of tip definition, and nasal tip asymmetry.RESULTS Sixty-four of the 69 patients who received revision rhinoplasty using the tripod technique during the study period were enrolled in the study. The tripod technique improved all of the following aesthetic and functional parameters (all P < .001). Nasal tip definition improved in 43 of 49 patients (88%). After surgery, projection was normal in 28 of 40 patients (70%) who had underprojection and overprojection preoperatively, and rotation improved in 29 of 38 patients (76%) who had overrotation or underrotation preoperatively. Columellar retraction improved after surgery in 18 of 24 patients (75%). The alar region improved in 41 of 52 patients (79%) who had alar retraction and/or pinch preoperatively, and inspiratory collapse improved in 49 of 50 patients (98%). CONCLUSIONS AND RELEVANCEThe tripod technique is an efficient surgical alternative for nasal tip reconstruction during revision rhinoplasty. This technique allows the destroyed cartilaginous framework to be recreated and returns original nasal tip appearance with stable results. LEVEL OF EVIDENCE 4

Current Surgical Outcomes of Nasal Tip Grafts in Rhinoplasty: A Systematic Review

“…Zeng et al 45 reported a “mushroom” combination graft composed of columellar strut with cap graft. Pedroza et al 46 addressed lateral cartilages as well as columellar retraction by utilizing a combination of seagull wing and shield grafts. Bracaglia et al 47 introduced a “rainbow graft,” which resolves asymmetry, dome angulation with cartilage interruption, alar pinch and retraction, and underprojection, all with a single graft.…”

Correction and prevention of tip asymmetries, bossae, and alar retraction

“…The alar spreader graft has historically been used to correct pinched tip deformity but is another option when attempting to correct medialization of the lateral crus, a potential cause of alar retraction. Kim et al suggest using alar spreader when simultaneously correcting alar retraction and an upturned tip [35,53] . In this scenario, both deformities can be addressed with the release of the nasal hinge and the scroll area, which helps to correct the upturned tip abnormality and simultaneously is a necessary step prior to alar spreader graft placement.…”