Introduction
The Asian nose is characterized by less height and length, less tip
projection, and a wider nasal base than its Caucasian
counterpart.1Another clinically meaningful anatomic
difference can be found in the soft-tissue envelope over the nasal
framework, which consists of a denser fibromuscular layer and a thicker
fatty layer.2These Asian features have prompted a need
for augmentation rhinoplasty for the dorsum, and as a result, a number
of techniques that increase nasal tip projection have been devised. The
lower lateral cartilages of Asians are small, the medial crura is
underdeveloped in most cases, and the soft tissue envelope of the tip is
thick. For these reasons, it is difficult to make significant changes to
nasal tip shape or position by applying suture techniques to lower
lateral cartilages. To obtain sufficient nasal tip projection,
structural supporting grafts such as the columellar strut graft or
septal extension graft are required in most Asians.1The columellar strut graft is the graft most commonly employed for nasal
tip projection. According toa comparative study performed by Young Chul
Suh et al. on septal extension and double-layered conchal
cartilage extension grafts, the latterbetter preserves septal support,
and may be an effective and safe alternative option for
rhinoplasty.3
Current views of nasal tip plasty remodeling in Asia are at odds with
classical understanding of nasal tip biomechanics. Though several
techniques were developed based on tripod theory first suggested by
Anderson in 1966, an increasing number of rhinoplasty surgeons now
appear to be following the “quadripod” concept of the nasal tip,
whereby the anterior caudal septum constitutes the fourth
leg.4
Cephalic tip rotation is a potential side effect of increasing
projection and resultsin frontal nostrilexposure and nasal
shortening.5We designed a more effective means of
achieving nasal tip projection, especially in terms of columellar
strutstrength, that simultaneously increases nasal tip protrusion and
controls cephalic rotation, by using a non-incisional, back-to-back,
bent double-layered, conchal cartilage extension graft in combination
with a pagoda-shaped onlay graft.