title: A multilayer cartilaginous tip-grafting technique for improved nasal tip refinement in Asian rhinoplasty.
abstract: OBJECTIVE
  Tip surgery remains the most difficult part of rhinoplasty in Asian patients because of the lower lateral cartilage characteristics and thick skin. The objective of this study was to evaluate the multilayer cartilaginous tip-grafting technique used for tip refinement in Korean patients undergoing rhinoplasty.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Academic tertiary care medical center.
  
  
  METHODS
  A retrospective study of 99 Korean patients who underwent open rhinoplasty involving multilayer cartilaginous tip-grafting for tip refinement was performed. Autologous septal, conchal, costal, or homologous costal cartilage, or a combination of these materials was used as grafting materials. Preoperative and postoperative photographs were reviewed for objective and subjective assessment of aesthetic outcomes.
  
  
  RESULTS
  Among patients, 7 had undergone previous rhinoplasty (7.1%), and removal of the previously placed silicone graft was required in 5 patients (5.1%). Two (6.7%), 3 (61.5%), 4 (28.8%), and 5 (3.0%) layers of cartilaginous graft were used. Postoperative aesthetic outcomes were graded as excellent in 63.6%, fair in 28.3%, and no change/worse in 8.1% of cases. Preoperative and postoperative objective measurements showed that the procedure resulted in increased nasal tip projection (0.52 ± 0.06 vs 0.57 ± 0.05; P < .05) and improved nasolabial angle (92.98° ± 9.95° vs 95.34° ± 8.20°; P < .05). The overall complication rate was 12.1%, and 8 patients required revision surgery (8.1%). Complications included infection (5.1%), visible graft contour (1.0%), nostril deformity (1.0%), overprojection (2.0%), and visible hypertrophic scar at the marginal incision site (3.0%).
  
  
  CONCLUSIONS
  The multilayer cartilaginous tip-grafting technique was found to be effective for aesthetic refinement of the nasal tip when used in rhinoplasty for Korean patients.
authors.affiliation: Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea. jangyj@amc.seoul.kr
authors.forename: Yong Ju
authors.initials: YJ
authors.lastname: Jang
authors.forename: Jin-Young
authors.initials: JY
authors.lastname: Min
authors.forename: Bedy Chung
authors.initials: BC
authors.lastname: Lau
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D055171:Nasal Cartilages / Q000637:transplantation*; D009667:Nose Deformities, Acquired / Q000453:epidemiology / Q000601:surgery*; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods*; D013536:Suture Techniques; D016896:Treatment Outcome; D055815:Young Adult