Background: To achieve the desired refinements in Asian patients, sufficient septal cartilage is needed for ideal tip projection and lengthening of the nose by the septal extension supported by the stable septum. There are many cases of insufficient septal cartilage in Asian patients. For optimal outcome, the author proposes a new technique, the so-called flag technique, which uses a tip-strut complex in a flag-like shape.
Methods: Using the open approach in 161 patients, an elongated columellar septal strut graft was sutured to the medial crura, and bilateral mini-spreader grafts in triangular or trapezoidal and flag-like shapes were attached bilaterally on both sides of the upper part of the strut graft, with a shield-shaped graft on the caudal edge of the upper part of the strut graft.
Results: There were significant improvements in three parameters for evaluating tip projection preoperatively and postoperatively. When compared with the ideal figure, the results are very effective in the ratio of tip projection to the distance from the tip to the vertical line of the upper lip, but there were significant differences in the ratio of nasal length (radix to tip) to tip projection and the ratio of alar base width to the width between each side of the tip-defining points.
Conclusion: The flag technique of using a tip-strut complex in a flag-like shape is an alternative method of tip-plasty in Asian rhinoplasty with insufficient septal cartilage.