Broad Tip Modification in Asian Patients Undergoing Rhinoplasty Using the Low-Lateral Cartilage Cruciate Overlap Technique

Overview

Asian rhinoplasty often focuses on narrowing a broad nasal tip. Reshaping the tip cartilage normally means cutting away its upper portion and discarding it. The authors argue this cartilage is useful for support and volume, and describe a cruciate overlap that rotates and reuses the strip. The method was first tested on cadaver heads.

Sections of note

• Five fresh cadaver head specimens were dissected to test the procedure before clinical use.
• 43 Chinese patients were operated between January 2011 and December 2013, with follow-up of 12 to 36 months to November 2014.
• The cartilage flap averaged 12.0 mm long and 3.0 mm wide, allowing 180 degree rotation and coverage of the graft site.
• Outcomes were rated on a 1 to 4 scale, where 4 means much improvement. Mean subjective score 3.3, mean objective score 3.5.
• Mean tip protrusion rose from 14.3 to 16.7 mm, mean tip width fell from 22.7 to 18.2 mm, and mean tip angle fell from 101.0 to 87.7 degrees, all p less than 0.001.
• Swelling, bruising and pain occurred early and resolved. No aesthetic or functional adverse effects were reported. Level of evidence 4.

What it means for a patient

• The technique reuses the patient's own cartilage rather than discarding it, avoiding a second harvest site.
• Measurements confirmed a narrower, more projecting tip, and results held over follow-up of at least one year.
• No complications were reported in 43 patients, but that group is too small to detect uncommon problems.
• Single centre, no comparison technique, and outcome grading was done by clinicians rather than through a patient questionnaire.

Why this paper matters

The broad, poorly defined tip is the central problem in much East Asian rhinoplasty, and support for the reshaped tip usually requires additional graft material. Turning waste cartilage into that support is an efficient answer. Whether the folded flap holds its position beyond three years is not addressed.

Terms

• Lower lateral cartilage: the paired cartilages that form and support the nasal tip.
• Cephalic portion: the upper part of that cartilage, commonly trimmed during tip surgery.
• Cruciate overlap: folding and crossing the cartilage strip over itself to add bulk and support.
• Tip projection or protrusion: how far the tip stands out from the face.
• Cadaveric dissection: testing of a technique on donated bodies.