Premaxillary Graft with Costal Cartilage in Rhinoplasty: A Technique to Support the Nasal Tip

Martins L, Fagundes MSC, Patrial MTCRO, Muñoz-Gonzalez C, Fakih-Gomez N.

PubMed 39325086 Publisher (DOI)Free full text (PMC)

What this paper says

In 38 patients given a rib cartilage graft placed in front of the bony base of the nose, tip support was maintained in every case with no displacement, extrusion or infection.

Overview

The facial skeleton underneath the nose provides its support and projection, and the upper jaw bone sits centrally in the midface. When that area is deficient, the base of the nose lacks a foundation. The authors placed a rib cartilage graft in front of the nasal spine in patients with premaxillary insufficiency, all operated by one surgeon between 2021 and 2022.

Sections of note

Design: case series, 38 patients, 5 men and 33 women, aged 18 to 58. Level of evidence IV.
All had open approach rhinoplasty with premaxillary insufficiency requiring a graft anterior to the nasal spine. Tip support was consistently maintained.
20 patients were randomly chosen for comparative measurement of the nasolabial angle on profile photographs, showing statistically significant improvement.
No complications such as graft displacement, scarring, extrusion or infection were reported.
The abstract states the 20 were drawn from 33 patients while the study enrolled 38, an internal inconsistency. No follow up length is stated, despite the conclusion claiming favorable long term outcomes.

What it means for a patient

A deficient premaxilla leaves the base of the nose without a solid foundation, which limits how well the tip can be supported from beneath.
The graft sits on bone rather than on cartilage, which is a different mechanism from a strut between the nostrils.
No graft moved, worked its way out or became infected, which are the failure modes for a graft placed against bone.
Limits: 38 patients, single surgeon, no comparison group, no stated follow up period, and measurement performed on a subset.

Why this paper matters

Tip support is usually addressed within the nose, with struts and extension grafts, while the bony platform underneath is rarely modified. Building up the premaxilla treats the foundation instead. Without a stated follow up duration, the claim of favorable long term outcomes is not supported by the abstract.

Terms

Premaxilla: the front part of the upper jaw bone, beneath the base of the nose.
Anterior nasal spine: the small bony projection at the base of the nose where the septum anchors.
Costal cartilage: cartilage from the ribs, harvested for use as a graft.
Nasolabial angle: the angle between the base of the nose and the upper lip.
Extrusion: a graft or implant working its way out through the skin or lining.

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

Abstract

Background: Rhinoplasty is an ever-evolving field, with innovative techniques continually being developed to enhance both aesthetic and functional outcomes for patients. Increasingly, research has focused on the integral role of the facial skeleton in providing nasal support and projection. Central to the structural integrity of the nose is the maxillary bone, which occupies a pivotal position in the midface.

Methods: The objective of this study is to assess the outcomes of patients who underwent rhinoplasty involving the placement of a premaxillary graft fashioned from costal cartilage. The study aims to evaluate the graft's tolerance, stability, and potential complications. The patient cohort comprised individuals who underwent open approach rhinoplasty with premaxillary insufficiency, necessitating the placement of a costal cartilage graft anterior to the nasal spine, performed by the same surgeon between 2021 and 2022. A total of 38 patients, consisting of 5 men and 33 women aged between 18 and 58 years, were operated on during this period.

Results: Consistent maintenance of tip support was observed across all cases. Among the 33 patients, 20 were randomly chosen for a comparative assessment of the nasolabial angle in preoperative and postoperative profile photographs, demonstrating a statistically significant improvement. No complications such as graft displacement, scarring, extrusion, or infections were reported.

Conclusion: The use of a premaxillary graft with costal cartilage appears to be a viable, well-tolerated option with favorable long-term outcomes.

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).