A procedure to prevent cephalic rotation of cartilage grafts in the nasal tip.

Background The mestizo patient usually has a small nose with a wide base, round nostrils, and a convex dorsum. The alar cartilages are weak, thin, and short, providing deficient structural support and poor definition of the nasal tip. Cartilage grafts in the nasal tip are very often used to correct this condition, but a common problem of this procedure is the cephalic or lateral rotation of these grafts. Objective We used an angulated extended columellar graft to give columellar support and projection to nasal tip grafts for better control and prediction of the position and effect of these grafts. Methods The surgical protocol included a medical history, development of a surgical plan by analysis of the deformity, and the use of pre- and postoperative photographs taken at both intermediate and long-term follow-up visits for evaluation of the results. Results Sixty-seven patients underwent surgery using this procedure, 56 with an open technique and 11 with a closed technique. Follow-up ranged from 6 months to 4 years. The results obtained were satisfactory, showing better control and prediction of the shape of the nasal tip. Conclusions The angulated extended columellar graft provides better control of the projection and angularity of cartilage grafts placed in the nasal tip. ( Aesthetic Surg J 2009;29:98–105. )