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

Area of Science:

• Plastic Surgery
• Rhinoplasty Techniques
• Nasal Anatomy

Background:

• Bulbous nasal tip surgery in patients with medium-to-thick skin and weak cartilage presents significant challenges.
• Suture-only techniques often fail to adequately maintain lateral crural support in these cases.

Purpose of the Study:

• To evaluate the efficacy of a modified lateral crural spanning graft technique for correcting bulbous nasal tips caused by lateral-crural pseudo-malposition.
• To assess the impact of this technique on rhinoplasty outcome evaluation (ROE) scores and complication rates.

Main Methods:

• A modified lateral crural spanning graft, termed the lower lateral cartilage spanning spring graft (LCSSG), was integrated with a septal extension graft (SEG).
• This cross-shaped construct was used in 17 primary rhinoplasty patients with bulbous nasal tip deformities.
• The graft was fixed to the cephalic borders of the lateral crura, creating a dynamic spring to reorient the crura and reinforce the alar rim.

Main Results:

• Seventeen patients (13 women, 4 men; mean age 32) with medium-to-thick skin were followed for a mean of 16.2 months.
• Mean ROE scores significantly improved from 12.6 preoperatively to 19.4 postoperatively (mean ΔROE of 6.8).
• The slit-anchored group (n=13) showed no complications, whereas the early suture-only group (n=4) had a 50% rate of mild supratip fullness and rim retraction.

Conclusions:

• The LCSSG-SEG construct effectively functions as a dynamic spring to reorient the lateral crus.
• This technique provides crucial support to the alar rim in primary rhinoplasty cases with lateral-crural pseudo-malposition and medium-to-thick skin.
• The slit-anchored LCSSG-SEG method demonstrates superior outcomes and safety compared to suture-only approaches in this patient population.