Abstract
Septal cartilage is deficient in Asians seeking augmentation rhinoplasty. Economized
utilization of resources is necessary for durable tip enhancement that complements
a dorsal implant. We introduce a modified tongue-in-groove method designed to transmit
forces across the dorsum, eliminating the need for robust caudal support and prioritizing
nasal lengthening and tip projection. We aim to promote the roundness index parameter
and demonstrate the feasibility of a novel method in the context of Asian rhinoplasty.
Between 2012 and 2014, a total of 104 Taiwanese patients underwent rhinoplasty with
dorsal augmentation and lengthening with a modified tongue-in-groove technique. The
concept borrows from methods established by Byrd, Guyuron, and Toriumi but distinguished
by exaggerated forward positioning of a septal extension graft. Paired extended spreader
grafts obviate the need for a columellar strut. Soft-tissue changes were analyzed
with photogrammetry. A new parameter, the roundness index, was measured. Tip projection,
dorsal length, nasal height, alar and columellar length increased significantly after
5.5 months of follow-up. Nasal tip angle, roundness, columella-labial angle, and nostril
axis inclination decreased. There were no statistically significant differences in
the magnitude of change in patients followed for less than and greater than 6 months.
The most common complication was new or persistent tip deviation in five cases (5%).
This technique was designed for a nasal anatomy typified by deficient septal cartilage.
Significant photogrammetric changes were maintained after 6 months. Economized tissue
allocation, dorsal septal load sharing, and relative independence from caudal support
are key features of this feasible method.
Keywords
rhinoplasty - spreader graft - ethnic Asian rhinoplasty
