Aesthetic Plastic Surgery

, Volume 43, Issue 3, pp 750–756 | Cite as

The Joint Tip Graft: A Joint Support for Rim, Facet and Infratip Lobule in Rhinoplasty

  • Sercan Gode
  • Goksel TurhalEmail author
  • Veysel Berber
  • Isa Kaya
  • Bulent Karci
  • Cemal Cingi
Original Article Rhinoplasty



The authors of this study have developed a novel graft called the ‘The Joint Tip Graft’ which adds support to the lateral crus, camouflages the tip grafts, supports the facet and adds volume to the nasal tip as a single graft. The aim of this study was to define and introduce the tripod graft.


Thirty patients who underwent primary rhinoplasty at a tertiary academic center were included. Patients were randomly assigned into two groups according to the grafts used: group 1: Joint tip graft was additionally used, and group 2: Joint tip graft was not used. All patients were photographed by a photographer who is familiar with medical photography. Preoperative and postoperative sixth month photographs were taken for analysis. The brightest point of the infratip lobule and the darkest point of the facets were selected and analyzed with computer software. The luminance ratio of facet to infratip lobule was calculated to overcome light and head position differences.


Mean infratip luminance scores were 112.20 ± 5.72 and 109.73 ± 7.13 in groups 1 and 2, respectively (p > 0.05). Mean facet luminance scores were 101.33 ± 4.91 and 89.27 ± 5.11 in groups 1 and 2, respectively (p < 0.05). Facet/infratip luminance ratios were calculated for each group. Mean facet/infratip luminance ratios were 0.90 ± 0.01 and 0.82 ± 0.16 for groups 1 and 2, respectively (p < 0.05).


The joint tip graft is a novel graft that is easy to harvest and apply. It spans both of the alar cartilages, supports the facet area and creates a smooth gradual light shadow transition. Additionally, it acts as a camouflage over the tip grafts.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Septorhinoplasty Rhinoplasty Joint tip graft Tip plasty Camouflage graft 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. It was approved by the institutional review board (approval no: 17-1.11/11).

Informed Consent

Written informed consent was obtained from the patients who participated in this study.

Supplementary material

Supplementary material 1 (WMV 29679 kb)

Supplementary material 2 (MOV 85894 kb)


  1. 1.
    Seneldir S, Nacar A, Kayabasoglu G (2015) A novel method for smooth contouring of nasal tip: camouflaging alar tip graft. J Craniofac Surg 26:2171–2173CrossRefPubMedGoogle Scholar
  2. 2.
    Brenner J, Hilger PA (2009) Grafting in rhinoplasty. Facial Plast Surg Clin North Am 17:91–113CrossRefPubMedGoogle Scholar
  3. 3.
    Toriumi DM (2006) New concepts in nasal tip contouring. Arch Facial Plast Surg 8:156–185CrossRefPubMedGoogle Scholar
  4. 4.
    Gunter JP, Hackney FL (2007) Adjusting rotation of the nasal tip. In: Gunter JP, Rohrich RJ, Adams WP (eds) Dallas rhinoplasty, 2nd edn. MO: Quality Medical Publishing, St. Louis, pp 375–400Google Scholar
  5. 5.
    Kridel RW (1995) Grafts and implants in revision rhinoplasty. Facial Plast Surg Clin North Am 3:473–486Google Scholar
  6. 6.
    Cingi C, Bayar Muluk N, Winkler A, Thomas JR (2018) Nasal Tip Grafts. Craniofac Surg 29:1914–1921Google Scholar
  7. 7.
    Cingi C, Muluk NB, Ulusoy S, Söken H, Altıntoprak N, Şahin E, Ada S (2015) Nasal tip sutures: techniques and indications. Am J Rhinol Allergy 29:e205–e211CrossRefPubMedGoogle Scholar
  8. 8.
    Farrior EH, Baller JA (2012) Nuances of the nasal tip: rhinoplasty of the thin-skinned nose. Facial Plast Surg 28:171–176CrossRefPubMedGoogle Scholar
  9. 9.
    Karaaltin MV, Karaaltin AB, Orhan KS, Demirel T, Guldiken Y (2012) Autologous fascia lata graft for contour restoration and camouflage in tertiary rhinoplasty. J Craniofac Surg 23:719–723CrossRefPubMedGoogle Scholar
  10. 10.
    Campbell CF, Pezeshk RA, Basci DS, Scheuer JF, Sieber DA, Rohrich RJ (2017) Preventing soft-tissue triangle collapse in modern rhinoplasty. Plast Reconstr Surg 140:33e–42eCrossRefPubMedGoogle Scholar
  11. 11.
    Guyuron B, Bigdeli Y, Sajjadian A (2015) Dynamics of the alar rim graft. Plast Reconstr Surg 135:981–986CrossRefPubMedGoogle Scholar
  12. 12.
    Gunter JP, Friedman RM (1997) Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg 99:943–952CrossRefGoogle Scholar
  13. 13.
    Burget G (2013) Discussion: reconstruction of the nasal soft triangle subunit. Plast Reconstr Surg 131:1051–1054CrossRefPubMedGoogle Scholar
  14. 14.
    Boahene KD, Hilger PA (2009) Alar rim grafting in rhinoplasty: indications, technique, and outcomes. Arch Facial Plast Surg 11:285–289CrossRefPubMedGoogle Scholar
  15. 15.
    Toriumi DM, Josen J, Weinberger M, Tardy ME Jr (1997) Use of alar batten grafts for correction of nasal valve collapse. Arch Otolaryngol Head Neck Surg 123:802–808CrossRefPubMedGoogle Scholar
  16. 16.
    Daniel RK (2008) Diced cartilage grafts in rhinoplasty surgery: current techniques and applications. Plast Reconstr Surg 122:1883–1891CrossRefPubMedGoogle Scholar
  17. 17.
    Kayabasoglu G, Ozbek E, Yanar S, Keles ON, Yilmaz MS, Guven M (2015) The comparison of the viability of crushed, morselized and diced cartilage grafts: a confocal microscopic study. Eur Arch Otorhinolaryngol 272:1135–1142CrossRefPubMedGoogle Scholar
  18. 18.
    Pedroza F, Pedroza LF, Achiques MT, Felipe E, Becerra F (2014) The tripod graft: nasal tip cartilage reconstruction during revision rhinoplasty. JAMA Facial Plast Surg 16:93–101CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  1. 1.Otolaryngology DepartmentEge University School of MedicineIzmirTurkey
  2. 2.Otolaryngology DepartmentOsmangazi University School of MedicineEskisehirTurkey

Personalised recommendations