Closed Rhinoplasty with a Mushroom-Shaped Costal Cartilage Graft in East Asian Patients

Overview

A bulbous, under-projected tip under thick skin is a common presentation in East Asian patients, and it requires a strong support graft to push the tip forward. This study used a rib cartilage graft carved into a mushroom shape, placed through a closed approach with no external incision.

Sections of note

• 52 patients underwent rhinoplasty with a mushroom-shaped costal cartilage graft between February 2018 and May 2019.
• Surgery was performed through a bilateral endonasal incision.
• All patients were photographed and asked to complete a satisfaction survey online or by telephone.
• Mean follow-up 15.8 months, range 12 to 21 months; 24 of 52 patients agreed to participate in the study.
• Postoperative means: nasofrontal angle 137.7 degrees SD 3.7, nasolabial angle 94.1 SD 6.2, nasal tip angle 79.4 SD 5.2, columellar-lobular angle 44.7 SD 2.4.
• Mean tip projection to nasal length index 0.53 SD 0.07; mean columellar to lobular length index 1.21 SD 0.22.
• No prolonged functional complications; 23 of 24 (95.8%) were satisfied with the aesthetic results. Level of evidence IV.

What it means for a patient

• The graft is shaped so a broader cap sits over a narrower stem, supporting and defining the tip.
• No external scar under the nose is created, since the work is done through the nostrils.
• Fewer than half of the treated patients, 24 of 52, participated in the assessment, so the satisfaction figure covers less than half the series.
• Limits: one institution, no comparison group, no preoperative measurements reported for comparison, and no rib donor site data.

Why this paper matters

Strong tip support in thick-skinned noses normally requires the open approach, and doing it through the nostrils avoids the external incision. Reporting objective angle measurements alongside satisfaction is a strength. The low participation rate is the main reason to read the satisfaction figure cautiously.

Terms

• Closed or endonasal rhinoplasty: Surgery done entirely through incisions inside the nostrils.
• Costal cartilage: Rib cartilage, used as a graft source.
• Bulbous tip: A rounded, undefined nasal tip.
• Tip projection: How far the tip stands out from the face.
• Columellar-lobular angle: The angle where the strip between the nostrils meets the underside of the tip.