X-shaped Tip Graft: A Versatile Solution for Warping Correction in Rib Cartilage–Based Rhinoplasty

Abstract

Background An enduringly stable tip graft is the key to achieve successful rhinoplasty case. However, the intrinsic nature of rib graft warping renders major unpredictability for the long-term outcome. Objectives The aim of this study was to detail and validate the utilization of a tip graft that is characterized by the circumferential split on the tip graft, which consequently renders a shape similar to the letter of X (Chi). Methods The counterrotating force applied intraoperatively and the complications that arose were collected retrospectively. Three-dimensional stereophotogrammetric evaluations of patients was performed. Anthropometric points were analyzed in a blinded fashion. Outcome variables were tip projection, nasal length, tip rotation and the n-prn angulation. Results Forty-five female patients, ranging in age from 18 to 41 years (average 28.5 years) completed the study. In all cases, the X graft was applied as one essential element for enhancing tip projection. Postoperative analysis showed great maintenance of tip position over time, evidenced by the insignificant change of n-prn angulation. Other postoperative evaluations including tip projection, nasal length and nasolabial angle had significant improvement. The differences were not statistically different between short- and long-term follow-up. Conclusions The X graft effectively mitigate the negative impact of graft warping. It is the ultimate form for tip support and elongating short noses. It has the merits of being versatility and flexibility when it comes to utilizing in establishing a strong and sustainable tip support in East Asian rhinoplasty.

Application of Modified V-Y Advancement Flap in Alar Base Reduction

“…A SEG and a strut graft will be placed to increase the convexity of the nasal columella in the above 2 cases when performed simultaneously with rib cartilage-related rhinoplasty. 29 It should also be noted that during the operation, when the contralateral side is operated after the completion of the first side, if asymmetry is detected, the symmetry of both sides can be adjusted by advancing the contralateral V-shaped flap in the opposite direction. It is also possible to correct postoperative asymmetries using this procedure.…”

“…This procedure is intended to increase the distance between the alar base and the columella base, which will improve the appearance of nasal alar hangings. A SEG and a strut graft will be placed to increase the convexity of the nasal columella in the above 2 cases when performed simultaneously with rib cartilage-related rhinoplasty 29 …”

1064nm Nd:YAG laser promotes chondrocytes regeneration and cartilage reshaping by upregulating local estrogen levels

“…In reconstructive surgeries of the ear or nose, rib cartilage is often carved and shaped before transplantation [45, 46]. However, after a period of transplantation, the transplanted cartilage may undergo deformation and shrinkage, possibly due to inadequate blood supply, infection, or the changed cartilage microenvironment in the recipient area, leading to apoptosis or contraction of chondrocytes [3, 47]. In this study, we used laser irradiation on autologous rib cartilage transplanted to the dorsal area of New Zealand rabbit noses and found that 1064nm Nd:YAG laser irradiation reduced cartilage contraction, deformation, and volume shrinkage.…”

“…During organ reconstruction, transplanted cartilage often undergoes deformation and absorption [1]. This issue is likely caused by an imbalance between external surface tension forces and internal tensile stresses [2,3]. This imbalance results in less‐than‐ideal shaping outcomes and decreased satisfaction with the reconstruction process [4‐6].…”

Promotion of diced cartilage survival and regeneration with grafting of small intestinal submucosa loaded with urine‐derived stem cells

“…Cartilage is a widely used autologous tissue in rhinoplasty for its advantages such as biocompatibility, low risk of infection, cost‐effectiveness and ample graft volume compared with alloplastic implants 1 . As we all know, cartilage graft applied in plastic surgery is to reinstate the volume, structural unity and strength in the corresponding parts of the body 2 . During the past decade, the technique of grafted cartilage has been improved constantly, 2 with examples including concentric carved costal cartilage, 3 oblique splitting cartilage, 4,5 transverse slicing cartilage, 6 accordion carved cartilage 7 and diced cartilage graft 8 .…”