Conjoint Shield and Onlay Tip Graft, a Duo for Nasal Tip Camouflage and Refinement in Rhinoplasty

Wu L, Wang H, Ma H, Li B, Tian L, Guo J, Zhang X, Fan F, You J.

PubMed 40195133 Publisher (DOI)Free full text (PMC)

What this paper says

In 41 patients, joining a shield graft and an onlay graft from rib cartilage into a single unit over the tip raised measured tip projection from 22.93 to 26.63 millimetres.

Overview

A tip graft that is not properly set can leave the tip looking narrow and pointed over time. To avoid that, the authors fixed a shield graft and a tip onlay graft together from rib cartilage, wrapping the top of the tip cartilage dome and the lower border of the tip graft. The combination acts as an overcoat, hiding irregularities from the assembled structures while adding width and thickness.

Sections of note

Design: retrospective study, 41 cases, ages 21 to 40. Level of evidence IV.
The combined grafts, named the duo combo grafts, were applied as the final step for camouflaging and refining the tip.
Assessment used three dimensional stereophotogrammetry with anthropometric points analyzed blinded.
Outcome variables: tip projection, nasal length and Goode ratio.
Tip projection rose from 22.93 to 26.63 millimetres.
Nasal length rose from 39.62 to 43.16 millimetres.
Goode ratio rose from 0.58 to 0.62.
The Global Aesthetic Improvement Scale gave an average score of 1.12.

What it means for a patient

Building a tip from several separate cartilage pieces can leave visible edges where they meet, and this graft is laid over the assembly to conceal them.
Adding width and thickness counters the pinched pointed look that develops when a tip graft is too narrow.
Blinded analysis of three dimensional measurements is stronger than surgeon assessment of photographs.
Limits: 41 patients, retrospective, no comparison group, no stated follow up length, and complications collected retrospectively without a stated rate.

Why this paper matters

Tip grafts are among the most visible parts of a rhinoplasty over the long term, since skin thins and edges emerge. A camouflage layer over the whole assembly addresses that directly. Whether it prevents the narrowing it was designed to avoid would require follow up over years.

Terms

Shield graft: a cartilage piece placed over the front of the tip to shape and project it.
Onlay graft: a cartilage piece laid on top of a structure to add height or bulk.
Alar dome: the peak of the lower nasal cartilage that forms the point of the tip.
Goode ratio: a photographic measure of tip projection relative to nasal length.
Stereophotogrammetry: measurement from paired images that capture three dimensional shape.
Global Aesthetic Improvement Scale: a rating of how much appearance improved after treatment.

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

Abstract

Background: An improperly established tip graft can lead to a narrow tip over time. To further refine the nasal tip and reduce the possibility of a narrow pointy tip, a shield graft and a tip onlay graft made from rib cartilage were fixated together and envelop the top of the alar dome and the caudal border of the tip graft. These conjoint grafts act as an overcoat, to camouflage any irregularities result in from assembling multiple structures together, while also providing supplementary width and thickness for tip and columellar improvement. We name these two conjoint grafts: the duo combo grafts.

Methods: A total of 41 cases were included in this retrospective study, ranging in age from 21 to 40 years. In all cases, the duo combo grafts were applied as the final element for camouflaging and finessing the nasal tip. The complications that arose were collected retrospectively. Three-dimensional stereophotogrammetric evaluations were performed. Anthropometric points were analyzed in a blinded fashion. Outcome variables were tip projection, nasal length and Goode ratio.

Results: Postoperative analysis suggested significant improvement on the aesthetics over time, evidenced by the significant increase in the tip projection (22.93 ± 1.32 vs 26.63 ± 1.35 mm), as well as the nasal length (39.62 ± 1.64 vs 43.16 ± 1.47 mm) and the Goode ratio (0.58 ± 0.038 vs 0.62 ± 0.031). Global aesthetic improvement scale also rendered an average score of 1.12 ± 0.40.

Conclusions: The duo grafts effectively camouflage and refine the nasal tip, imparting a pleasingly contoured and harmonious appearance. It has the merits of anatomically compliance and flexibility when it comes to concomitantly improving the tip profile. We propose that our findings provide a new perspective on the potential benefits of the duo graft, which can be considered a valuable addition to the armamentarium of rhinoplasty surgeons.

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).