Tip graft malposition displacement

One of the most common techniques in open structure rhinoplasty, either primary, revisional or ethnic, is some kind of tip grafting to define, position, augment, shape and model the nasal tip. Tip grafting is one of the most creative, artistic and challenging rhinoplasty techniques, demanding the best skills, judgment and planning from the surgeon.

The main goal is achieving the desired effect with the tip graft but preventing its presence is detectable or adds any kind of deformity; being naturalness and undetectability absolutely feasible goals, however and eventually the graft placed at the tip might partially or totally shift or have been place improperly; if it is too high located leads to upturned and overrotated tip, tombstone deformity, etc; if it is located too low produces polly beak deformity, droopy tip, etc; when it is displaced to one of the sides it creates tip lopsidedness and bossing.

To prevent the deformities due to tip graft shifting or malpositioning the surgeon has to shape, tailor, carve and model the graft in a highly customized to patient's nose anatomy fashion, considering critical factors like the thickness and transparency of the skin, the amount of subcutaneous tissue, the firmness and shape of the cartilage employed for the graft, the projecting vector towards the skin, etc.

Very specific maneuvers aiming to prevent graft malpositioning are a must, grafts be rather placed and adjusted via open approach rhinoplasty and secured with fixation sutures to the underlying tissues.

Patients warning: only highly experienced surgeons who have underwent optimal training and have performed already a large number of closed approach and non structure rhinoplasties should execute nose grafting and structure rhinoplasty cases, should they feel capable and comfortable with the challenge.