Discussion
In our preliminary series the main indication for surgery was a short nose (N=18), severe under projection or - rotation of the nasal tip (N=22), over-rotation of the nasal tip (N=6), excess columellar show (N=8). The T-graft is a multifunctional structure, made of one single piece of cartilage. This property has advantages compared to a combination of single grafts like a septal extension graft in combination with extended spreader grafts and a nasal tip graft, like a shield- or cap graft. Compared to single grafts the T-graft is more stable and economic in cartilage consumption. The technique of the T-graft can be combined with all kinds of modifications of the lower lateral cartilages. For example, with suture techniques such as lateral crural steal or dome creation sutures but also with lateral crural overlay, lateral strut grafts or (articulated) rim grafts. In case the T-graft is not exactly in the midline the caudal margin of the graft can be beveled before TIG fixation of the lower laterals. Additional suture fixation can be performed using a “columellar retraction suture” [4]. The advantage of this mattress suture technique is that the columella does not come forward (caudal) when the footplates of the lower laterals are brought closer to the T-graft. As a consequence, the nasolabial angle will not increase as seen with a traditional mattress suture in this area.
Informed consent was obtained from the patients involved in this report. There are no conflicts of interest.
Taken together, the T-graft makes it easy and straightforward to create a well- balanced nasal framework both for beginners and more experienced rhinoplastic surgeons.