Broad Tip Modification in Asian Patients Undergoing Rhinoplasty Using the Low-Lateral Cartilage Cruciate Overlap Technique

Abstract

Importance

Asian patients undergoing cosmetic rhinoplasty often want surgeons to concentrate on the broad nasal tip. Modifying the cartilage framework is considered to be the fundamental strategy; during the modification procedures, the cephalic portion of the lower lateral cartilage is often excised and discarded. However, given the supporting function and volumetric filling properties of autologous cartilage, the cephalic cartilage should and can be salvaged by using our cruciate overlap technique.

Objectives

To introduce a novel technique in modification of broad nasal tip in Asian patients undergoing rhinoplasty and assess its efficacy and safety.

Design, Setting, and Participants

Dissection of 5 fresh cadaver head specimens was performed and the plausibility and reliability of the new procedure were determined at Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. In addition, the cruciate overlap technique was performed in 43 Chinese patients between January 1, 2011, and December 31, 2013, and the surgical results were assessed subjectively and objectively during the follow-up period, ranging from 12 to 36 months, with the final follow-up November 30, 2014. Anthropometric measurements of patients’ noses preoperatively and postoperatively were taken and the patients’ complications were reviewed.

Main Outcomes and Measures

Cadaveric evaluation, subjective and objective assessments of the surgical results (rated on a scale of 1 to 4, with 4 indicating much improvement from the preoperative level), nasal measurements of the patients, and evaluation of the complications.

Results

The mean size of the cartilaginous flap in the cruciate overlap technique was 12.0 mm long and 3.0 mm wide, allowing for 180° rotation and graft coverage, with the nasal cartilage framework protected from collapse. Mean (SD) scores for the subjective and objective judgment of the outcomes were 3.3 (0.4) and 3.5 (0.3), respectively. Moreover, nasal measurements demonstrated significant postoperative improvement by increasing the mean nasal tip protrusion (from 14.3 [1.5] to 16.7 [2.0] mm) and reducing the mean tip width (from 22.7 [1.7] to 18.2 [1.6] mm) and tip angle (from 101.0° [6.3°] to 87.7° [6.7°]) (all P < .001). Acceptable ranges of edema, ecchymosis, and pain were observed in the early postoperative period and resolved within a short period. No aesthetic or functional adverse effects were reported during the follow-up period.

Conclusions and Relevance

The cruciate overlap technique is an efficacious and reliable alternative for modification of broad nasal tips in Asian patients undergoing rhinoplasty.

Level of Evidence

4.