Download PDF
Facial Plast Surg
DOI: 10.1055/a-2764-3269
Original Article

Structural Nasal Tip Grafting: Anatomy, Evaluation, and Technique Selection for Durable Aesthetic and Functional Outcomes

Authors

  • Nam K. Lee 

    1   Department of Otolaryngology – Head and Neck Surgery, University of Colorado at Anschutz Medical Campus, Aurora, Colorado, United States

  • Andrew A. Winkler 

    1   Department of Otolaryngology – Head and Neck Surgery, University of Colorado at Anschutz Medical Campus, Aurora, Colorado, United States
Further Information
Also available at
   Permissions and Reprints

Corrected by:

Corrigendum: Structural Nasal Tip Grafting: Anatomy, Evaluation, and Technique Selection for Durable Aesthetic and Functional OutcomesFacial Plast Surg eFirst
DOI: 10.1055/a-2793-0191

Abstract

Aims and Backgrounds

This study aims to review contemporary principles of structural nasal tip grafting and provide a practical framework for selecting techniques that achieve durable aesthetic and functional outcomes.

Historical Aspects

We summarize the evolution from reduction rhinoplasty toward preservation and structural approaches that prioritize long-term tip support.

Anatomy

Key osteocartilaginous and soft tissue support mechanisms of the nasal tip are outlined with emphasis on major and minor tip support structures.

Technology

Open and endonasal approaches, autologous cartilage sources, and ancillary materials such as fascia are described as tools to modify tip contour and support.

Patient Selection

Clinical assessment focuses on skin–soft tissue envelope, cartilage strength, airway function, and dynamic deformities.

Techniques

Stepwise algorithms for columellar strut and septal extension grafts, plumping grafts, alar rim and batten grafts, lateral crural struts, shield and cap grafts, and articulated alar rim grafts are presented.

Post Operative Care

Postoperative management to protect graft position and control edema is reviewed.

Current and Future Development

Emerging trends toward individualized, data-informed rhinoplasty and objective outcomes assessment are discussed.

Conclusions and Clinical Relevance

Thoughtful selection and execution of structural tip grafts allow surgeons to achieve stable, reproducible tip shape while optimizing nasal airway function.

Keywords

nasal tip - rhinoplasty - structural grafting - septal extension graft - alar rim graft

Ethical Approval

This article is a narrative and technique-focused review and does not involve new studies with human participants or animals. No identifiable patient information or clinical images are included.




Publication History

Received: 14 November 2025

Accepted: 03 December 2025

Accepted Manuscript online:
05 December 2025

Article published online:
15 December 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Daniel RK. The nasal tip: Anatomy and aesthetics. Plast Reconstr Surg 1992; 89 (02) 216-224
    Search in Google Scholar
  • 2 Rohrich RJ, Adams Jr WP. The boxy nasal tip: Classification and management based on alar cartilage suturing techniques. Plast Reconstr Surg 2001; 107 (07) 1849-1863 , discussion 1864–1868
    Search in Google Scholar
  • 3 Sheen JH. Aesthetic Rhinoplasty. 2nd ed.. Quality Medical Publishing; 1998
    Search in Google Scholar
  • 4 Alkan Z, Acioglu E, Yigit O. et al. Determining the most suitable costal cartilage level for rhinoplasty: An experimental study. Otolaryngol Head Neck Surg 2012; 146 (03) 377-381
    Search in Google Scholar
  • 5 Alkan Z, Yigit O, Acioglu E. et al. Tensile characteristics of costal and septal cartilages used as graft materials. Arch Facial Plast Surg 2011; 13 (05) 322-326
    Search in Google Scholar
  • 6 Byrd HS, Andochick S, Copit S, Walton KG. Septal extension grafts: A method of controlling tip projection shape. Plast Reconstr Surg 1997; 100 (04) 999-1010
    Search in Google Scholar
  • 7 Yap E. Management of ala columella disproportion in South East Asian noses. Facial Plast Surg 2020; 36 (05) 505-516
    Search in Google Scholar
  • 8 Fischer H, Gubisch W. Nasal valves–importance and surgical procedures. Facial Plast Surg 2006; 22 (04) 266-280
    Search in Google Scholar
  • 9 Cervelli V, Spallone D, Bottini JD. et al. Alar batten cartilage graft: Treatment of internal and external nasal valve collapse. Aesthetic Plast Surg 2009; 33 (04) 625-634
    Search in Google Scholar
  • 10 Porter JP, Tardy Jr ME, Cheng J. The contoured auricular projection graft for nasal tip projection. Arch Facial Plast Surg 1999; 1 (04) 312-315
    Search in Google Scholar
  • 11 Tugertimur B, Datta S, Goote P. et al. Mastoid fascia tissue graft as a tip camouflage technique in rhinoplasty: A reliable alternative to soft cartilage grafts. Plast Reconstr Surg 2025; 155 (02) 255-262
    Search in Google Scholar
  • 12 Davis RE. Lateral crural tensioning for refinement of the wide and underprojected nasal tip: Rethinking the lateral crural steal. Facial Plast Surg Clin North Am 2015; 23 (01) 23-53
    Search in Google Scholar
  • 13 Nguyen E, Flaherty AJ, Akkina SR, Kidwai S, Nuara MJ. Patient-reported functional and aesthetic outcomes of underlay articulated alar rim grafts in functional septorhinoplasty. Facial Plast Surg Aesthet Med 2023; 25 (03) 274-275
    Search in Google Scholar