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Page 12 of 16 Won et al. Plast Aesthet Res 2019;6:6 I http://dx.doi.org/10.20517/2347-9264.2018.82

A B

Figure 16. Costal cartilage used for tip-plasty. A dorsal graft, cap graft and bilateral lateral crural onlay grafts are shown (A);
perichondrium covered over the cap graft can conceal irregularities (B)

A B

D C

Figure 17. Warping of dorsal onlay rib graft. A 25-year-old man who had revision rhinoplasty with rib cartilage developed warping of the
dorsal implant (A); during the revision surgery, the warped costal cartilage graft was removed, recarved, and reinserted with mastoid
periosteum reinforcement over the radix (B, C); frontal view 6 months after surgery shows a straightened dorsum (D)

Flat and straight pieces of cartilage were carved from his 6th costal cartilage using a No. 10 blade. After
dividing the lower lateral cartilages and elevating the septal mucosa, a septal extension graft was designed
from the rib cartilage to reach the anterior nasal spine inferiorly and to extend the nasal tip anteriorly while
rotating it caudally. The septal extension graft was reinforced with a septal batten graft and an extended
spreader graft to prevent twisting forces.

Afterwards, extended lateral crural strut grafts were employed to strengthen the lateral compartment and
match the elongated central compartment [Figure 18D-F]. After completely separating the lateral crus from