摘要

Objectives: One of the most important and difficult aspects of rhinoplastic surgery is creating an elegant, nicely shaped, natural appearing nasal tip with respect to the proportionality of its width and projection Introduction: The most well-known nasal tip grafts are the sheen shield graft, the Peck onlay graft and the Guyuron modification; all these grafts are issued from septal cartilage. I herein propose a new tip graft “Achkar tip graft” issued from the dorsal hump that can be used in primary rhinoplasty or in some secondary rhinoplasty. Materials / method: The three-dimensional cartilage issued from the dorsal hump is cut perpendicularly to the long axis of the dorsal hump and it results in a three wings T shaped cartilage. This T shaped structure have three wings; it is composed of the nasal septum cartilage (the hard wing) and the upper right and left lateral cartilages (the soft wings). This graft is named “Achkar tip graft” and will be used as a tip graft material. The positioning of the graft depends essentially on the thickness of the skin of the nose; when the skin is thick, I put the hardest wing toward the front tip and when it is thin, Results: “Achkar tip graft” forms a ligand binding-like fact that binds perfectly to the underlying alar cartilage and columellar strut, which permit a rapid orientation and fixation. Conclusion: The “Achkar tip graft” can be easily used in any nose shape with non-defined, over projected or under projected tip; it is also indicated when the skin of the nasal tip is thin or thick. The most important advantages of this graft are the easy and the rapid orientation of the nasal tip to having an excellent result.