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.