Free Crushed Cartilage Filler Graft to Optimize Tip Aesthetics in Asian Rhinoplasty

Chang BL, Cho WK, Jang YJ.

PubMed 39322839 Publisher (DOI)Free full text (PMC)

What this paper says

In 66 Asian patients followed for a mean 16.3 months, crushed cartilage placed loosely over the tip framework at the end of surgery lengthened the nose 8.3% and raised the tip 12.7%, with 12.1% reporting aesthetic dissatisfaction but no revisions.

Overview

Thick skin and weak cartilage mean Asian tip surgery usually needs substantial structural grafts, which can leave small edges or irregularities visible only as the skin is closed. Jang's group describes placing free crushed cartilage as a "filler graft" over the framework to smooth and refine the tip with immediate visual feedback. They reviewed all patients with at least 12 months of follow-up.

Sections of note

66 patients; mean follow-up 16.3 months.
Nasal length increased 8.3% and tip height 12.7% versus preoperative (both P < 0.01).
Aesthetic complications: amorphous tip 6.1%, irregular or asymmetric tip 3.0%, visible tip graft 4.5%.
12.1% expressed dissatisfaction; none was recommended for or pursued revision.
Level of Evidence III.

What it means for a patient

Crushed cartilage acts as a natural, autologous smoothing layer under the tip skin.
About 1 in 8 patients were not fully satisfied, mostly with subtle tip shape issues, though none had a revision.
The technique is an add-on at the end of structural tip surgery, not a substitute for it.

Why this paper matters

It documents a simple finishing technique from a high-volume Asian rhinoplasty centre with honest reporting of minor aesthetic complications. Limits: retrospective, single surgeon, no comparison group.

Terms

Crushed cartilage: cartilage flattened with a crusher so it becomes soft and mouldable.
Free graft: tissue placed without a blood supply, relying on the surrounding tissue to sustain it.
Amorphous tip: a tip lacking clear definition or shape.
Columellar-labial angle: the angle between the columella and the upper lip.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Background: The thick skin and weak cartilages make tip rhinoplasty very challenging in Asian patients. Most require an open approach for structural grafting in order to achieve the desired projection and rotation. This need for substantial tip grafting may result in subtle imperfections that are only noticed as the incisions are closed.

Objectives: This study describes the senior author's technique of free crushed cartilage filler graft to optimize nasal tip aesthetics in Asian rhinoplasty. The goal is to introduce this easy-to-use and effective technique to refine the final nasal tip aesthetic with immediate visual and tactile feedback.

Methods: This is a retrospective review of all patients with free crushed cartilage filler graft with at least 12 months of follow-up. Medical records were reviewed for patient demographics, intra-operative manoeuvres, and complications. Photographs were analysed to evaluate changes in nasal length, tip height, and nasolabial and columellar-labial angles as well as aesthetic complications.

Results: Sixty-six patients were included in this study, with an average follow-up of 16.3 months. Nasal length was 8.3% greater than pre-op (P < 0.01), and nasal tip height was 12.7% greater than pre-op (P < 0.01). Aesthetic analysis demonstrated that 6.1% of patients had an amorphous tip, 3.0% had an irregular or asymmetric tip, and 4.5% had visible tip grafts. 12.1% of patients expressed aesthetic dissatisfaction, but none was recommended for or pursued revision surgery.

Conclusions: When used correctly, free crushed cartilage filler graft can improve the final tip aesthetic and help camouflage underlying prominences to give the patient a natural result.

Level Of Evidence Iii: 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).