The Plug-in Graft, the Essential Supplement for a Stable Cartilaginous Framework in Rhinoplasty

Abstract Background A stable cartilaginous framework establishes the foundation for a successful rhinoplasty procedure. However, the curvature of the anterior septal angle usually does not match the added tip graft, leaving a structural gap that can cause postoperative rotation of the nasal tip. A supplementary graft is required to fill this gap, consolidating this structure in 3 dimensions. Objectives The aim of this study was to detail and validate the utilization of a graft that fills the structural gap, producing a more stabilized framework and better-sustained tip position in the long term. Methods The counterrotating force applied intraoperatively and the complications that arose were collected retrospectively. Three-dimensional stereophotogrammetric evaluations were performed. Anthropometric points were analyzed in a blinded fashion. Outcome variables were tip projection, nasal length, Goode’s ratio, and tip rotation. Results were compared statistically. Results Thirty-one female patients, ranging in age from 18 to 41 years, completed the study. Intraoperative measurements of rotation indicated an unequivocal stabilizing effect of the plug-in graft. Postoperative analysis showed excellent maintenance of the tip position over time. Tip projection and nasolabial angle decreased slightly over time, but the differences were not statistically different. Conclusions The plug-in graft evidently consolidates the entire cartilaginous framework in rib-based rhinoplasty procedures. This anatomically integrated structure establishes the fundamental groundwork which provides uncompromising support for the tip graft, thereby achieving an aesthetically pleasing and long-lasting outcome. When executed properly, this graft is effective in maintaining postoperative tip position, justifying the technical challenges involved and the prolonged operating time. Level of Evidence: 4