X-shaped Tip Graft: A Versatile Solution for Warping Correction in Rib Cartilage-Based Rhinoplasty

Wu L, You J, Wang H, Tian L, Xu Y, Zheng R, Zhang X, Guo J, Fan F.

What this paper says

In 45 women having rib cartilage rhinoplasty, a tip graft split around its circumference into an X shape held tip position over time, with no significant change in the angle between the nose root and tip.

Overview

A stable tip graft is central to a successful rhinoplasty, but rib cartilage has an intrinsic tendency to warp, which makes long term results unpredictable. The authors describe and assess a tip graft made by cutting a split around the circumference of the graft, producing a shape resembling the letter X. Intraoperative measurements and complications were examined retrospectively, with three dimensional photographic assessment afterward.

Sections of note

Retrospective study with three dimensional photographic evaluation; 45 female patients aged 18 to 41, average 28.5 years.
Measurement points were analysed in a blinded fashion.
Outcome variables were tip projection, nasal length, tip rotation and the angle between the nose root and the tip.
The X graft was applied in all cases as an essential element for enhancing tip projection.
Tip position was maintained over time, shown by insignificant changes in that angle.
Tip projection, nasal length and nasolabial angle all improved significantly.
Differences between short term and long term follow up were not statistically significant.
The authors state the graft mitigates the negative impact of graft warping.

What it means for a patient

Warping is the main reason rib based results shift over time, and the split design is intended to release the internal stresses that cause it.
Tip position held between the early and later assessments.
Forty five patients from one group with no comparison graft design is limited evidence.
The abstract does not state the follow up duration or the complication rate.

Why this paper matters

Rib cartilage is the main graft source when septal cartilage runs out, and warping is its defining weakness. This design addresses warping through shape rather than through carving technique or fixation. Whether it outperforms other tip grafts has not been compared.

Terms

Tip graft: cartilage placed at the tip to shape or project it.
Warping: gradual bending of a cartilage graft after placement.
Tip projection: how far the tip stands out from the face.
Pronasale: the most forward point of the nasal tip.
Stereophotogrammetry: three dimensional measurement built from photographs.
Counterrotating force: force tending to rotate the tip downward.

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

From the abstract

“An enduringly stable tip graft is the key to achieving successful rhinoplasty. However, the intrinsic tendency of rib grafts to warp renders the long-term outcome of cartilage-based rhinoplasty highly unpredictable. Objectives: The aim of this study was to detail and validate the utilization of a tip graft that is…”

Excerpt; the full abstract is on PubMed.