The Lower Lateral Cartilage-Spanning Spring Graft (The Gullwing Effect)

Bulbous nasal tip surgery due to lateral-crural pseudo-malposition in medium-to-thick skin with weak cartilage is often challenging. Suture-only maneuvers may not reliably maintain the lateral-crural resting angle in such anatomy.

A modification of the lateral crural spanning graft was used in 17 consecutive primary rhinoplasty patients with bulbous tip deformity due to lateral-crural pseudo-malposition. A single-layer septal cartilage strip (lower lateral cartilage spanning spring graft, LCSSG) was integrated into a septal extension graft (SEG) through a slit, forming a cross-shaped construct. The LCSSG limbs rested on the cephalic borders of the lateral crura and were fixed with 5-0 PDS, creating a spring that reoriented the lateral crura and reinforced the alar rim. Demographics, skin thickness, fixation variant, follow-up, complications, and rhinoplasty outcome evaluation (ROE) scores were recorded.

Seventeen primary cases (13 women, 4 men; mean age 32 years) with medium-to-thick skin (11 thick, 6 medium) were followed for a mean of 16.2 ± 5.4 months (range, 9-26). Mean ROE improved from 12.6 ± 3.1 (5-16) preoperatively to 19.4 ± 2.0 (13-22) postoperatively, with a mean ΔROE of 6.8 ± 3.4 (3-14). In the early suture-only group (n = 4), ΔROE was 6.8 ± 4.8 (3-13) and two patients (50%) developed mild supratip fullness with slight rim retraction. In the slit-anchored group (n = 13), ΔROE was 6.8 ± 3.1 (3-14) and no complications occurred.

The LCSSG-SEG construct provides a dynamic spring that reorients the lateral crus and supports the alar rim in primary cases with lateral-crural pseudo-malposition and medium-to-thick skin.

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