Bilateral Tip Add-On Grafts: Concept, Applications and Complications in East Asian Rhinoplasty

Background: solid tip support plays the fundamental role in augmentation rhinoplasty for East Asians. However, the soft tissue envelope is sometimes limited; the bilateral alae and mucosae cannot be transposed to consolidate the full course of the strut. A graft that serves for the ultimate purpose of elongating the valid length of the strut is therefore necessary. Methods: Forty-one female patients, ranging in age from 19 to 35 years (average 26.5 years), received augmentation rhinoplasty surgery that was supplemented by the applications of the bilateral accessory add-on tip grafts. The tip projection was established by columellar strut or septal extension grafts. These crescent-shaped grafts acted like a bridge between the alae and the strut, which aim to provide supplementary volume and surface area to help reduce tension and further define the width and shape of the nasal tip. Results: Patients' own evaluations on the overall improvements of the nose rendered high satisfaction rate. During the follow-up, six cases presented deviated columella and asymmetrical nostrils; three cases had deformed dorsal profile due to graft warping or resorption at 12 to 18-month period postoperatively, and were corrected during revision surgeries. No other major complications were encountered. Conclusions: These accessory tip add-on grafts are intrinsically applicable for East Asians rhinoplasty surgeries. Instead of being utilized as a routine graft for normal circumstances, this pair of accessory tips is an expedient measure to solve a difficult situation. This graft will be particularly necessary in managing a severely short nose with interior soft tissue insufficiency.