The comma-shaped tip cartilage graft.

Conventional onlay grafts of cartilage to the tip, columella, and alar margin provide valuable techniques for the refinement of minor deformities in both primary and secondary rhinoplasty. However, they cannot produce a full restoration of the dynamic anatomy of the lower lateral cartilages, which give forward thrust and arch support to the tip and nostril margins. For these grosser problems another graft design has been devised by the author. A report is given of the successful use of a comma-shaped septal graft used for over five years in selected cases of secondary rhinoplasty. The graft replaces the deficient lateral crus and alar dome and is sculpted and then sprung into position so that it restores function and gives the desired aesthetic effect.