Modification of Nasal Dorsal Onlay Graft Based on Anatomic Findings of Rhinion Area.

[BACKGROUND] The angulation of nasal bones and superior border of septal cartilage forms a slight convex profile at rhinion area. Taking this angulation into account, we bring forth a modification of dorsal onlay graft.

[METHODS] Sixty-one consecutive patients underwent primary rhinoplasty between the years of 2017 and 2020 were enrolled in the study. The angle between nasal bones and superior border of septal cartilage, angle of external dorsal contour, thickness of soft tissue at sellion and rhinion were measured on reformed computed tomographic scanning image. Three variants of dorsal onlay graft modification were designed.

[RESULTS] Sixty-one patients underwent primary nasal augmentation were enrolled in this study. Mean follow-up was 13.1 months. The angle between nasal bones and the superior border of the septal cartilage was 166.7° by mean. Mean angle of external dorsal contour was 180.2°. Thickness of soft tissue at sellion was 4.01 and 2.03 mm at rhinion by mean. All cases showed content dorsal profiles. Two patients (3.3%) presented discernible nostril asymmetry due to the deviation of the columellar grafts and underwent secondary surgery with satisfying outcomes.

[CONCLUSIONS] Modification of the dorsal onlay graft reserves nasal midvault to the most extent especially in small-humped nose and fits the dorsal contour properly.

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