Asian's Nose Cartilage

The more delicate cartilaginous tissues of the lower lateral cartilage generally require reinforcement with autogenous cartilage from the ear or septum to obtain a desired result. Affecting a result with pure cartilage reshaping techniques is difficult and usually inadequate. Septal cartilage frequently requires two-layered reinforcement because of its thinness.
Generally, the lower lateral cartilage is too soft and pliable to adequately support the tip. Such softness precludes the successful use of onlay grafts to the tip, except for the rare patient who has sufficiently strong cartilage (about 10% of patients). While septal cartilage appears adequate for tip projection in closed rhinoplasty, the compromise of circulation at the tip when using the open rhinoplasty approach may contribute to long-term weakness, absorption of the septal cartilage, or both. Conchal cartilage grafts placed as a strut appear to have a more durable outcome. When tip grafting, defatting should be limited in order to decrease the likelihood of graft visibility. This is particularly true in the open approach, as the 2-layered graft combined with a columella incision can lead to compromised circulation at the tip area and more significant scarring.