Subdorsal Cantilever Graft for Elevating the Dorsum in Ethnic Rhinoplasty

Augmentation of the nasal dorsum is frequently required in the ethnic rhinoplasty patient to create a narrowing effect and to balance the upper two thirds of the nose with the desired increase in tip projection. The subdorsal cantilever graft (SDCG) provides a method to elevate the nasal dorsum to complement the increase in nasal tip projection. SDCG type A is situated below the bony dorsum and acts to raise the dorsum with limited elevation of the radix. The SDCG type B extends through a radix osteotomy site and raises the radix down to the supratip after complete release of the bony dorsum and middle nasal vault. Placement of the SDCG below the dorsum has many advantages, including preserving the features of the natural dorsum (dorsal aesthetic lines), controlled narrowing, and camouflage of the subdorsal graft. This is a complex procedure that requires a good understanding of dorsal preservation techniques. Use of the SDCG to raise the nasal dorsum in ethnic patients combines structure rhinoplasty with the principles of dorsal preservation for augmentation of the profile in patients with a low dorsum.