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Nasal Tip Stability without Contour Irregularities: The Mastoid Fascia Hybrid Graft

Jaime L Bernstein, MD MS1, Shaishav Datta, MD2, Steven Hanna, MD, FRCSC3, David Mattos, MD, MBA4, Richard Reish, MD, FACS1 and Kylie Edinger, MD5, (1)Manhattan Eye, Ear and Throat Hospital, New York, NY, (2)University of Toronto, Toronto, ON, Canada, (3)Private Practice, Toronto, ON, Canada, (4)New York Plastic Surgical Group, New York, NY, (5)Manhattan Eye and Ear Hospital, New York, NY
Goals/Purpose: Rhinoplasty is both a complex and challenging surgical procedure, particularly when it comes to addressing the nasal tip. The primary considerations not only include achieving ideal projection and rotation, but more importantly achieving long-lasting, predictable results. Our group previously demonstrated the success of a mastoid fascia graft in camouflaging and concealing nasal tip contour irregularities, however, sometimes the nasal tip needs more projection than the fascia graft alone can provide. For these patients, we have introduced the nasal tip hybrid graft (HTG) which combines our previously described mastoid fascia tip graft with an underlay of lower lateral cartilage, excised during surgery, to provide additional projection and definition, while not compromising the ability to conceal contour irregularities.

Methods/Technique: A retrospective analysis of HTG for nasal tip aesthetics during open rhinoplasty in the senior author’s practice was conducted from May 2021 to June 2022. The HTG is created with gently crushed, excised, lower lateral cartilage to decrease memory while maintaining structural integrity with an overlay of mastoid fascia graft. Patients were included in the study if they underwent open rhinoplasty with hybrid tip graft and at least 12 months of follow-up documented. Patients were evaluated for need for revision surgery or infection. Patients routinely receive empiric post operative antibiotics.

Results/Complications: 729 patients met the inclusion criteria within the time frame, 666 female and 63 male patients with an average age of 31.9 years old (14-89) at the time of surgery. Primary rhinoplasties were performed on 510 (70%) patients, with 219 (30%) secondary or revisions performed. Average follow up was 21.9 months (12-36). 21 patients required extended antibiotics. 11 patients (1.5%) required a revision surgery, of which only 2 (0.3%) were initially primary rhinoplasties. Of the revision surgeries, only 4 (0.5%) were revisions that required the tip to be readdressed.

Conclusion: HTG is a safe, novel method to provide additional nasal tip projection, with stable results, that do not compromise the ability to camouflage tip irregularities due to the underlying lower lateral cartilage and soft overlying mastoid fascia. This technique can also be used with other soft cartilage when necessary. Use of HTG is associated with minimal morbidity and is a useful, predictable tool in many rhinoplasty patients.

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