Introduction
The main goal in rhinoplasty is to create a well-balanced nasal skeleton that dictates a new shape to the overlying soft tissue envelope that is in pleasing harmony with the rest of the face. Nasal length, nasal tip projection and -rotation, the amount of columellar show as well as other aspects should all be in harmony. To reach this goal a combination of surgical techniques can be applied such as resection or reallocation of bone and cartilage, or adding structure and support using nasal grafts. In literature, most of the described grafts used in rhinoplasty have one specific function. For example, the spreader graft to reconstruct the roof of the middle vault [1], or a septal extension graft to lengthen the nasal septum [2]. The T-graft is different, it is a multifunctional graft. Depending on the position of the graft in relation to the caudal septum, it can be used as a septal batten- , splinting- or septal extension graft. The graft has two extensions (Figure 1). One extension at the caudal-anterior margin that acts like a columella strut graft. This structure allows the surgeon to very accurately control the position of the domes or tip defining points but also the nasolabial angle. The second extension is positioned at the posterior site of the T-graft. This spreader-like extension is helpful to control deviations of the caudal cartilaginous septum and to provide additional stabilization of the graft. Due to its multifunctional character the T-graft allows the surgeon to increase nasal tip support and to control nasal length as well as nasal tip projection and -rotation. These abilities make the T- graft helpful in finding the “sweet-spot” regarding nasal length, nasal tip projection and rotation. In other words, this graft is a new tool in creating a well-balanced and aesthetical pleasing shape of the nose. The T-graft is indicated in many anatomical features like in patients with a short nose or heavy soft tissue envelope, but also in patients with under projection of the nasal tip, under- or over-rotation of the nasal tip and deviations of the caudal nasal septum.