The Sherpa Model of Training and the Future of Surgical Mentoring.

BACKGROUND

: Precise nasal tip refinement is a cornerstone of Asian rhinoplasty that addresses characteristics such as bulbous tips, short columellas, and flared nostrils. The septal extension graft (SEG) and the derotation graft (DRG) are commonly used to enhance tip projection; however, comparative analyses are lacking. The authors assessed the outcomes of the SEG and the DRG in Asian patients who underwent tip-plasty.

METHODS

: In this retrospective study, the authors analyzed 729 patients who underwent nasal tip-plasty using the SEG or the DRG between January of 2011 and December of 2017. Postoperative complications were assessed after a minimum follow-up of 6 months. For patients with long-term follow-up (≥24 months), nasal tip projection (NTP) and columellar-labial angle were measured preoperatively and postoperatively using the Goode and the Byrd methods.

RESULTS

: Among 287 SEG and 142 DRG cases, both techniques showed significant postoperative improvements: SEG (ΔNTP-Goode = 0.036, = 0.001; ΔNTP-Byrd = 0.036, < 0.001) and DRG (ΔNTP-Goode = 0.047, = 0.005; ΔNTP-Byrd = 0.053, < 0.001). No significant differences were noted for NTP ratios (Goode, = 0.954; Byrd, = 0.452) or columellar-labial angle ( = 0.116). Complications included more tip-columella deviations in the SEG group (5.23% versus 1.41%) and higher tip drooping (4.53% versus 8.45%; adjusted = 0.040) and supratip deformity (0% versus 2.82%; adjusted = 0.010) in the DRG group.

CONCLUSIONS

: Longitudinal analysis shows that both the SEG and the DRG effectively preserve tip projection over time. The SEG is more prone to tip and columellar deviations, whereas the DRG is associated with tip drooping and supratip deformity, with no difference in tip-shortening relapse. Technique selection should be customized to the patient’s anatomical features and the surgeon’s experience to minimize complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, III.