Tip Refinement Grafts: The Designer Tip.

In cosmetic rhinoplasty, the patient's satisfaction is most often determined by the quality of the tip surgery, but perfecting a technique for consistently attractive tips can be challenging. As a result, rhinoplasty surgery is now entering a new era of "designer tip" operations, wherein surgeons can employ a combination of open suture tip techniques and tip refinement grafts to achieve consistent results. The grafts are made from excised lateral crural cartilage and, depending upon the specific aesthetic goals, the shape can include the following:domal, shield, diamond, folded, or combination. It is possible to alter dome-defining points, tip point, projection,definition, volume, and size and shape. A study of 100 consecutive female rhinoplasties indicated that tip sutures alone were used in 36% of cases, while a tip refinement graft was added to a sutured tip in 59% of cases.