Tip graft: a 20-year retrospective.

This paper chronicles a personal experience with nasal tip grafts over 20 years. In the first period (1968-1975), the original graft was designed for use in secondary rhinoplasty cases to obtain both projection of the tip and increased angulation at the columellar-lobular junction. The use was soon expanded to primary patients with inadequate tip projection. During the middle period (1975-1982), the applications for tip grafting were expanded to include many kinds of tip problems (both primary and secondary), cleft lip noses, and various ethnic noses, especially those with thick skin. The incidence of postoperative displacement and/or visibility of the graft was reduced as multiple grafts of solid, bruised, and crushed cartilage became routine. Ear cartilage was first used and ethmoid was abandoned as a primary graft. The incidence of infection was significantly reduced. The current period (1982-1991) is marked by refinements in technique and materials. Greater versatility with graft composition and materials makes possible a variety of tip configurations, custom-made for individual requirements.