title: Modified tip grafts and tip punch devices.
abstract: BACKGROUND
  Nasal tip aesthetics depend on the graceful synergism between soft tissue and the underlying frame. Nasal projection and the nasal tip width are the two most important components of nasal aesthetics. The cartilage graft, which has a predictable ability to affect several of the anatomical components contributing to nasal tip aesthetics, is one of the most versatile tools used to modify nasal projection. The fundamental shortcoming of the current graft sculpturing technique, namely, the requirement of time to create an optimal tip graft, prompted the design of a tool for the precise and rapid sculpturing of cartilage used for nasal tip onlay and shield grafts.
  
  
  METHODS
  This report describes a modified design of the Peck and Sheen grafts and introduces a new instrument, the tip graft punch. The unique features of the tip graft punch that facilitate the production of a symmetric, precisely proportioned cartilage grafts are highlighted.
  
  
  RESULTS
  The tip graft punch has been successfully used on 49 patients over the past 2 years.
  
  
  CONCLUSIONS
  The authors report a modification of nasal tip grafts and a simple and useful device for harvesting these grafts. This modification produces more natural and aesthetically pleasing results. The device saves surgery time, and provides a symmetric and anatomical graft design.
authors: Cleveland, Ohio From the Department of Plastic Surgery, Case Western Reserve University.
authors: Bahman
authors: B
authors: Guyuron
authors: David
authors: D
authors: Jackowe
mesh_terms: D000328:Adult; D002356:Cartilage / Q000637:transplantation*; D004425:Ear Cartilage / Q000637:transplantation; D004954:Esthetics; D005260:Female; D006801:Humans; D008297:Male; D009300:Nasal Septum; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000295:instrumentation / Q000379:methods; D014182:Transplantation, Autologous / Q000295:instrumentation / Q000379:methods; D016042:Transplantation, Heterotopic / Q000295:instrumentation / Q000379:methods