The tripod graft: nasal tip cartilage reconstruction during revision rhinoplasty

Overview

Revision surgery often has to rebuild a nasal tip whose cartilage was removed or weakened at an earlier operation. This retrospective study from a clinic in Bogota, Colombia reviewed patients treated between 2007 and 2012 who needed the tripod technique. Tip problems were diagnosed from photographs taken before surgery and compared with photographs taken after. Both appearance and breathing were recorded.

Sections of note

• Retrospective descriptive study; 64 of the 69 patients who received the technique were enrolled.
• Photographs were reviewed monthly for three months, then at 6, 9 and 12 months.
• Measures were projection, rotation, columellar and alar retraction, alar pinch, tip definition and tip asymmetry.
• Tip definition improved in 43 of 49 patients (88 percent).
• Projection became normal in 28 of 40 patients (70 percent) and rotation improved in 29 of 38 (76 percent).
• Columellar retraction improved in 18 of 24 (75 percent), alar retraction or pinch in 41 of 52 (79 percent), and inspiratory collapse in 49 of 50 (98 percent), all at P less than .001.

What it means for a patient

• A damaged tip framework can be rebuilt rather than only reshaped, and this series reports gains in both looks and airflow.
• There was no comparison group and no randomisation, so the results cannot be measured against another technique.
• Assessment came from photographs graded by the treating team, and follow-up ran to twelve months.

Why this paper matters

Tip reconstruction is a central problem in revision rhinoplasty, and this paper describes one structured approach with counted outcomes. It does not show how the tripod technique compares with other grafting methods, or whether the gains hold beyond one year.

Terms

• Revision rhinoplasty: a second or later nose operation to correct a previous result.
• Nasal tip projection: how far the tip stands out from the face.
• Tip rotation: the upward or downward angle of the tip.
• Columellar retraction: the strip of tissue between the nostrils sitting too high.
• Alar pinch: a squeezed, narrowed look to the nostril rim.
• Inspiratory collapse: the nostril sidewall caving inward when breathing in.