The Joint Tip Graft: A Joint Support for Rim, Facet and Infratip Lobule in Rhinoplasty

Overview

The facet is the small triangular hollow between the tip and the nostril rim, and it casts a shadow that shows whether a tip looks natural. The authors developed one graft that supports the tip cartilage, covers other tip grafts, and fills the facet at the same time, then measured the resulting light reflections.

Sections of note

• 30 patients undergoing primary rhinoplasty at a tertiary academic center, randomly assigned to two groups: with the joint tip graft, or without.
• All patients were photographed by a medical photographer, before surgery and at 6 months.
• The brightest point of the infratip lobule and the darkest point of the facets were selected and analyzed with computer software.
• A facet to infratip luminance ratio was calculated to control for lighting and head position differences.
• Mean infratip luminance: 112.20 SD 5.72 versus 109.73 SD 7.13, not significant, p above 0.05.
• Mean facet luminance: 101.33 SD 4.91 versus 89.27 SD 5.11, significant, p below 0.05.
• Mean facet to infratip ratio: 0.90 SD 0.01 versus 0.82 SD 0.16, significant, p below 0.05. Level of evidence IV.

What it means for a patient

• The graft reduced the shadow in the small hollow beside the tip, producing a smoother gradation of light.
• One graft performs several jobs at once, which reduces the number of separate pieces placed.
• Limits: 30 patients in two groups of 15, one center, 6 months of follow-up, and outcome measured only as photographic brightness rather than patient satisfaction or breathing.
• Brightness ratios measure light reflection, which relates to but is not the same as how a nose looks to a person.

Why this paper matters

Tip refinement is usually judged by eye, and this uses a measurable photographic proxy with a randomized comparison. Consolidating several graft functions into one piece is practical. The sample is small and no patient-reported outcome accompanies the measurements.

Terms

• Facet: The small triangular hollow between the nasal tip and the nostril rim.
• Infratip lobule: The area of the tip just below its highest point.
• Lateral crus: The outer arm of the tip cartilage.
• Luminance: The measured brightness of an area in an image.
• Camouflage: Covering a graft so its edges do not show through the skin.