A Modified Large-Cap Graft in East Asian Revision Rhinoplasty

Zheng R, Dong W, Han R, Xu Y, Fan F.

PubMed 35577970 Publisher (DOI)Free full text (PMC)

What this paper says

In 91 East Asian revision rhinoplasty patients given a modified large cap graft at the tip, satisfaction scores rose from 11.66 to 17.30, with complications in 3.3 percent at the donor site and 7.7 percent at the nose.

Overview

Rebuilding a well defined nasal tip is difficult in East Asian patients, particularly with tip irregularities or a short nose after previous surgery. The study reports experience with a modified large cap graft for tip contour in revision rhinoplasty, in 91 patients, 81 female and 10 male, mean age 26.8 plus or minus 6.7 years.

Sections of note

Retrospective review of 91 patients; level of evidence IV.
Patient satisfaction was measured with the Rhinoplasty Outcome Evaluation.
Appearance was assessed from photographs by two blinded plastic surgeons using the Independent Rhinoplasty Outcome Score.
Overall satisfaction rose from 11.66 plus or minus 3.98 to 17.30 plus or minus 5.03, P less than 0.001.
The surgeons' assessment of nasal contour gave an overall score of 3.77 plus or minus 0.42.
Donor site complications occurred in 3.3 percent: pleural tear 1.1 percent and thickened scar 2.2 percent.
Recipient site complications occurred in 7.7 percent: warping 3.3 percent, extrusion 1.1 percent, deviation 2.2 percent and infection 1.1 percent.

What it means for a patient

The graft is placed over the tip to define its shape, in noses already operated on.
About one patient in nine had a complication at the nose and one in 30 at the donor site.
A pleural tear means the lining around the lung was breached during rib harvest.
Blinded independent raters were used, though there was no comparison group and no stated follow up length.

Why this paper matters

Tip definition is the central goal in East Asian revision rhinoplasty and is limited by scarred, thin tissue and depleted cartilage. This series reports one graft design with both patient and blinded surgeon assessment. Whether it outperforms other tip grafts has not been compared.

Terms

Cap graft: cartilage placed over the tip cartilages to shape and define the tip.
Revision rhinoplasty: surgery on a nose that has already been operated on.
Warping: gradual bending of a cartilage graft after placement.
Extrusion: a graft working its way out through skin or lining.
Pleural tear: a breach of the lining around the lung, a risk during rib harvest.
Blinded assessment: rating done by someone who does not know which images are before or after.

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

Abstract

Background: Reconstructing a well-defined nasal tip is a big challenge for East Asian patients, especially with nasal tip irregularities or short noses in revision rhinoplasty. This study aims to report our experience with a modified large-cap graft for improving the contour of the nasal tip in revision rhinoplasty.

Methods: A retrospective review was conducted for 91 patients (81 females, 10 males; mean age, 26.8 ± 6.7 years) who underwent revision rhinoplasty with a modified large-cap graft. The rhinoplasty outcome evaluation (ROE) was used for investigating patient satisfaction. The aesthetic outcomes were assessed by preoperative and postoperative photographs by two blinded plastic surgeons using the Independent Rhinoplasty Outcome Score.

Results: Most patients reported satisfactory aesthetic outcomes with overall ROE score increasing from preoperative 11.66 ± 3.98 to postoperative 17.30 ± 5.03 (p < 0.001). The doctors' evaluations on the improved contour of the nose rendered an overall score of 3.77 ± 0.42. The complication rate was 3.3% (pleural tear, 1.1%; hypertrophic scar, 2.2%) at the donor site, and 7.7% at the recipient site (warping, 3.3%; extrusion, 1.1%; deviation, 2.2%; infection, 1.1%). No other complications were observed during follow-up.

Conclusions: Large-cap graft may be safe and efficient for reconstructing contour of the nasal tip in revision rhinoplasty for East Asian patients.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).