Conjoint Shield and Onlay Tip Graft, a Duo for Nasal Tip Camouflage and Refinement in Rhinoplasty.

Abstract

Background: An improperly established tip graft can lead to a narrow tip over time. To further refine the nasal tip and reduce the possibility of a narrow pointy tip, a shield graft and a tip onlay graft made from rib cartilage were fixated together and envelop the top of the alar dome and the caudal border of the tip graft. These conjoint grafts act as an overcoat, to camouflage any irregularities result in from assembling multiple structures together, while also providing supplementary width and thickness for tip and columellar improvement. We name these two conjoint grafts: the duo combo grafts.

Methods: A total of 41 cases were included in this retrospective study, ranging in age from 21 to 40 years. In all cases, the duo combo grafts were applied as the final element for camouflaging and finessing the nasal tip. The complications that arose were collected retrospectively. Three-dimensional stereophotogrammetric evaluations were performed. Anthropometric points were analyzed in a blinded fashion. Outcome variables were tip projection, nasal length and Goode ratio.

Results: Postoperative analysis suggested significant improvement on the aesthetics over time, evidenced by the significant increase in the tip projection (22.93 ± 1.32 vs 26.63 ± 1.35 mm), as well as the nasal length (39.62 ± 1.64 vs 43.16 ± 1.47 mm) and the Goode ratio (0.58 ± 0.038 vs 0.62 ± 0.031). Global aesthetic improvement scale also rendered an average score of 1.12 ± 0.40.

Conclusions: The duo grafts effectively camouflage and refine the nasal tip, imparting a pleasingly contoured and harmonious appearance. It has the merits of anatomically compliance and flexibility when it comes to concomitantly improving the tip profile. We propose that our findings provide a new perspective on the potential benefits of the duo graft, which can be considered a valuable addition to the armamentarium of rhinoplasty surgeons.

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