Bilateral Tip Add-On Grafts: Concept, Applications and Complications in East Asian Rhinoplasty

Wu L, Wang H, Xu Y, Zhang X, Fan F, You J.

PubMed 34085104 Publisher (DOI)

What this paper says

In 41 women given paired crescent shaped add on tip grafts during augmentation rhinoplasty, six developed a deviated columella with uneven nostrils and three had a deformed bridge from graft warping or absorption within 12 to 18 months.

Overview

Solid tip support is fundamental to augmentation rhinoplasty in East Asian patients, but the authors state the soft tissue covering is sometimes too limited to wrap around the full length of the support strut. They designed a graft to extend the usable length of that strut. The paired crescent shaped grafts act as a bridge between the nostril wings and the strut.

Sections of note

Case series of 41 female patients, age 19 to 35, average 26.5 years; the journal assigns level of evidence IV.
Tip projection was set with a columellar strut or a septal extension graft; the add on grafts were supplementary.
The grafts add volume and surface area, intended to reduce tension and define the width and shape of the tip.
Patients rated overall improvement themselves, described as a high satisfaction rate with no figures given.
Six cases had a deviated columella with asymmetric nostrils.
Three cases had a deformed bridge profile from graft warping or resorption at 12 to 18 months, corrected at revision surgery.
The authors state the graft is not routine but an expedient for difficult cases, particularly a severely short nose with insufficient internal soft tissue.

What it means for a patient

Nine of 41 patients, about 22 percent, needed a revision within the reported period.
The grafts are described by the authors as a solution for difficult cases rather than standard practice.
Satisfaction was self reported without a validated questionnaire and there was no comparison group.
Follow up reported only as 12 to 18 months is limited evidence.

Why this paper matters

When the skin and lining are too tight to cover a tip support, the framework cannot be extended without tension, which is a recurring limit in short nose correction. This paper describes a structural workaround and reports its failure rate honestly. Whether it outperforms other options for the short nose is untested.

Terms

Add on tip graft: an extra piece of cartilage added to broaden or extend the tip support.
Columellar strut: a cartilage post between the nostrils supporting the tip.
Septal extension graft: cartilage attached to the septum to set tip position.
Soft tissue envelope: the skin, fat and lining covering the nasal framework.
Warping: gradual bending of a cartilage graft after surgery.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

From the abstract

“A solid tip support plays the fundamental role in augmentation rhinoplasty for East Asians. However, the soft tissue envelope is sometimes limited; the bilateral alae and mucosae cannot be transposed to consolidate the full course of the strut. A graft that serves for the ultimate purpose of elongating the valid…”

Excerpt; the full abstract is on PubMed.