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Rhinoplasty surgery is an osteocartilaginous operation, meaning changes are made to the bone and cartilage supporting structures. Ultimately the final aesthetic results is in how these changes are done and how much they show through the overlying skin as it shrinks and contracts around the reshaped nasal framework.

Such osteocartilaginous framework changes can be done through removal (reductive) or addition (augmentation) changes and many rhinoplasties contain an assortment of both types of changes. This ie best illustrated in the nasal tip where certain areas of cartilage are removed (e.g., cephalic alar resection), reshaped (dome suturing) or augmented. (cartilage tip grafting)

Nasal tip grafting with cartilage has been extensively done since the widespread adoption of the open rhinoplasty approach. It is performed for a wide variety of reasons including changing tip projection and/or rotation as well as creating greater tip refinement.

One cartilage augmentation technique to the tip is the cap graft. As the name implies it is a small cartilage graft that can potentially cover the entire tip like a cap. It can be used to make a nasal tip more round or cover a wide spacing (cleft) between the two dome points. It can also be used to provide an extra millimeter or two of tip projection by adding a thin cartilage layer across it.

While the largest use of cartilage grafting in the tip is the columellar strut graft to provide support and/or increase tip projection, smaller grafts can be used to refine the tip shape. Such grafts can come from a variety of sources such as the remnants of a cephalic lower alarm cartilage trim or from a remaining septal graft harvest. Applying the grafts with small 6-0 resorable sutures allows for good graft security while minimizing the size of the overlying knots.

Dr. Barry Eppley

Indianapolis, Indiana

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