Subdorsal Cantilever Graft for Elevating the Dorsum in Ethnic Rhinoplasty

Overview

Raising the nasal bridge is frequently required in ethnic rhinoplasty to narrow the nose and to balance the upper two thirds against the intended increase in tip projection. The subdorsal cantilever graft provides a way to elevate the bridge to match that tip change. Placing the graft beneath rather than on top of the bridge is the defining feature.

Sections of note

• Technique article; the abstract reports no patient numbers, no outcomes, no complication rates and no follow up.
• Type A sits below the bony bridge and raises it with limited elevation of the radix.
• Type B extends through a bone cut at the radix and raises the radix down to the supratip, after complete release of the bony bridge and middle vault.
• Stated advantages of placing the graft below the bridge include preserving the natural dorsal aesthetic lines.
• Further stated advantages are controlled narrowing and concealment of the graft itself.
• The author describes it as a complex procedure requiring good understanding of dorsal preservation techniques.
• The technique combines structural rhinoplasty with dorsal preservation principles for patients with a low bridge.

What it means for a patient

• A graft placed under the bridge raises it from beneath, so the natural surface and its shadow lines remain visible.
• That contrasts with an onlay graft laid on top, whose edges can show through thin skin.
• Two versions exist depending on whether the root of the nose also needs raising.
• No results, complication rates or comparisons are reported, and the author states the procedure is complex.

Why this paper matters

Bridge augmentation in low bridged noses usually relies on grafts laid on top, which are the source of visible edges and irregularity. This technique moves the graft underneath. Whether it produces better contour or fewer visible problems has not been measured.

Terms

• Subdorsal cantilever graft: a graft placed beneath the bridge, supported at one end, to raise it.
• Dorsal augmentation: raising the height of the nasal bridge.
• Radix: the root of the nose between the eyes.
• Supratip: the area of the bridge just above the tip.
• Dorsal aesthetic lines: the two shadow lines running down the bridge from the brows to the tip.
• Dorsal preservation: keeping the natural bridge rather than cutting it away.