A new concept in the tip plasty of Asian rhinoplasty: the flag technique by use of only a septal cartilage

Overview

Lengthening the nose and raising the tip in Asian rhinoplasty usually depends on having enough septal cartilage to build a septal extension. Many Asian patients do not have enough. The author describes the flag technique, which assembles several small pieces into a tip-strut complex shaped like a flag on a pole, using only septal cartilage.

Sections of note

• 161 patients operated through the open approach.
• An elongated columellar septal strut graft was sutured to the medial crura.
• Bilateral mini-spreader grafts, triangular or trapezoidal and flag-like, were attached on both sides of the upper strut.
• A shield-shaped graft was placed on the lower front edge of the upper strut.
• Three measures of tip projection improved significantly from before to after surgery.
• Results matched the ideal for the ratio of tip projection to the tip-to-upper-lip line, but differed significantly from ideal for nasal length to tip projection and for alar base width to tip width.

What it means for a patient

• The technique is aimed at patients whose own septal cartilage is too scarce for a standard septal extension graft.
• Tip projection improved reliably across a large group of patients.
• Two proportions did not reach the reference ideal, so the nose was improved rather than made to match a textbook figure.
• No complication rate, follow-up duration, comparison group or patient satisfaction data are given in the abstract, and all cases come from one surgeon.

Why this paper matters

Cartilage supply is the limiting factor in much Asian rhinoplasty, and the alternatives are rib harvest or synthetic implants, both with their own costs. A method that stretches a small amount of septal cartilage addresses that directly. Whether the assembled construct holds its shape over years is not reported.

Terms

• Tip plasty: surgery to reshape the tip of the nose.
• Septal cartilage: the cartilage of the partition inside the nose, the usual first-choice graft source.
• Septal extension graft: cartilage attached to the septum to lengthen the nose and set tip position.
• Medial crura: the paired lower cartilages inside the columella that support the tip.
• Spreader graft: a narrow cartilage strip placed alongside the septum, here used in miniature form.
• Shield graft: a flat cartilage piece placed on the front of the tip to add definition.