A newly designed minigraft to achieve angularity and projection of the nasal tip: the asymmetrical bipyramidal graft.

A new systematization for onlay tip grafting is described, using a minigraft constructed from either irradiated, glutaraldehyde-processed bovine cartilage or soft-grade silicone blocks. The graft design consists of two pyramidal volumes amputated in the apex and carved with mild concave surfaces. The lateral profile of the graft is asymmetrical with an acute inclination in the front and a slight inclination in the back. The graft height ranges from 1.5 to 3.8 mm. With this type of implant, high tip projection with a natural appearance can be achieved easily. Since 1986, we have performed 39 tip implants (12 cartilage grafts and 27 silicone grafts). Silicone graft fate has been excellent with no complications, whereas cartilage grafts underwent a 25% resorption rate. Thus, the current technique is now solely undertaken with silicone minigrafts. Main indications are primary tip plasty in normal-size noses with poor tip projection, and secondary noses. This technique is not recommended for simultaneous use with primary rhinoplasty. For more than 4 years, this technique has provided consistent results, being highly effective in achieving the objective of increasing tip projection.