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The aim of this in vivo study is to compare cartilage viability within diced cartilage grafts from the perspective of three wrapping biomaterials Group A acellular dermal matrix (FlexHD®), Group T bovine pericardium (Tutopatch®), and Group F allogeneic human fascia for a possible implementation in the clinical use.

This in vivo study was conducted on 5 SCID (Severe Combined Immunodeficiency)/Gamma Mice with a duration of eight weeks. The cartilage within composite grafts were obtained from the remaining cartilage following secondary rhinoplasty performed on a single donor. Diced cartilage grafts were wrapped separately with acellular dermal matrix (ADM), bovine pericardium, and fascia to form three groups. A total of five mice were utilized in all three experimental groups, with a total of 15 experimental materials being examined. One composite graft from each group was implanted into the backs of the mice. The effects of the biomaterials on the viability and stability of the composite grafts were evaluated. Viability was evaluated through LIVE/DEAD cell analysis and histopathological examinations. Stability was assessed by comparing weight and volume changes of the grafts, measured using a precision balance and computed tomography, respectively.

A significant increase in weight was found in the fascia group after implantation (p < 0.05). In the ADM (Group A) and bovine pericardium (Group T), no statistically significant weight change was observed (p > 0.05). A significant increase in volume was found in the ADM (Group A) group after implantation (p < 0.05). Flow cytometry showed the highest cartilage viability percentage in the fascia (Group F) and the lowest in the ADM (Group A). No significant difference was found in viability percentages between the groups. Histopathological examinations supported the flow cytometry findings.

Our study revealed that cartilage grafts wrapped in allogenic fascia (Group F) showed better viability and stability compared with ADM (Group A) and bovine pericardium (Group T). This suggests that while fascia may remain the gold standard, alternative biomaterials also hold potential. Further experimental and clinical studies with larger sample sizes are needed to support these findings.

Shape of the tip is supplied by lower lateral cartilages (LLC) which are divided into three crurae each composed of two segments divided by junction lines. Tip restoration becomes more complicated with the presence of angulation deformities (A.D.) over LLC. It is aimed to classify A.D. based on their relationship to junction lines, to clarify their causes of the formation and to discuss current restoration techniques for each of them.

Between 2016 - 2025, 1125 primary rhinoplasties have been performed. All types of the A.D. have been retrospectively determined, renamed. Six different types of A.D. have been encountered in this series. Four of A.D. (Types A,B,C,D) have been located over junction lines and two of A.D. (Types S,T) have not been located over junction lines.

Type-A A.D. diverging the footplates were observed in 27 patients, Type-B A.D. resulting in a boxy-nose were observed in 54 patients, Type-C A.D. resulting in acute angulation of the dome at the medial genu were observed in 16 patients, Type-D A.D. resulting in a pinched tip and concave alar wings were observed in 24 patients, Type-S A.D. resulting in a weak, and short columella were observed in 15 patients, Type-T A.D. that creates a bulge over ala was observed just in 3 patient in our series. The total number of patients with A.D. was 139 (12.35 % of all cases).

A.D. are encountered in considerable amount of rhinoplasty patients. Some of them are hidden deformities. Some of them are combined deformities. Classification of A.D. over LLC based on their relationship to certain junction lines provides ease for recognition of these deformities and immediate per-operative planning for their restoration.

Since a few referrals complained of upper blepharoptosis or epicanthal fold (EF) formation following their rhinoplasty, this study was designed to investigate the incidence of possible eyelid and medial canthal changes following a rhinoplasty procedure.

This is a retrospective pre- and post-operative (at least 12 months) photo analysis of the subjects with open rhinoplasty in 2019 and 2020. Margin reflex distance (MRD)1 and 2, tarsal plate show (TPS), and intercanthal distance (ICD) were measured by two masked observers and the average of 3 measurements was recorded. Furthermore, pre- and postoperative photos were randomly demonstrated to two masked oculoplastic surgeons to grade the epicanthal fold as grade 1 (no epicanthal fold) through grade 4 (congruent upper and lower lid connection).

Analysis was performed on 272 subjects (544 hemi-face), predominantly female (88.6%), with a mean age of 30.4 years (SD=8.7). A newly developed grade 2 epicanthal fold was observed either bilateral (1 subject) or unilateral (3 subjects) in 4 subjects (1.4%). An increased mean postoperative MRD1 (0.2mm on the right and 0.3mm on the left, P<0.01) and consequently decreased TPS (0.1mm on the eight, P<0.01 and 0.05mm on the left, P= 0.3) were observed. MRD2 significantly decreased by 0.10mm on the right and 0.13 on the left side (P<0.01). The ICD was also significantly (P<0.01) decreased by 1.2 mm.

There was no blepharoptosis after the rhinoplasty. Postoperative grade 2 epicanthal fold was observed in 1.4% of the subjects. This potential complication should be explicitly included in the preoperative informed consent form. While some eyelid changes were statically significant, they were not clinically significant, indicated that the functional and aesthetic impact on the eyelids was minimal.

Nasal tip stability is crucial for long-lasting results. Usage of the extension graft is one of the most reliable stabilization techniques. With a septum in the midline, the extension graft is fixed end-to-end. The "jig-saw puzzle technique” reinforces this end-to-end fixation.
The specific protrusion on one piece of the puzzle is inserted in a groove on adjacent piece. This settlement provides stabilization between the pieces. Application of this philosophy between the nasal septum and extension graft may provide a lifelong fixation.

Between April 2022 and March 2024, the "jig-saw puzzle technique" was applied in 26 female patients. Trapezoid-shaped protrusion was created at the septum. Similar indentation was created at the extension grafts. The protrusion is then settled in the indentation. The pre-op, immediate post-operative and one-year post-operative pictures are compared to assess the rotations and projections with Adobe Photoshop Program.

All 26 patients were female with mean age 27.5 years (20-32). Satisfactory graft stabilization was obtained without loss of projection and rotation in all patients. Statistically significant difference was found between the preoperative, immediate postoperative, and postoperative 1-year projection and rotation assessments of the patients (p=0.001; p<0.01)
The results were evaluated at a 95% confidence interval and significance was evaluated at p<0.05 level. These statistical analyses verify that both projection and rotation were preserved with jig-saw puzzle technique"

The jigsaw puzzle technique may provide suture-independent, lifetime end-to-end fixation opportunity of the septal cartilage and the extension graft.

Thick nasal skin and increased supratip soft-tissue volume remain challenging factors in rhinoplasty. Despite adequate structural support, postoperative supratip fullness and limited tip definition may occur due to persistent dead space, prolonged edema, and scar formation, potentially leading to pollybeak deformity.To describe a supratip control suture technique designed to reduce supratip dead space and improve supratip contour and tip definition in thick-skinned rhinoplasty patients.

We report our experience from a high-volume rhinoplasty center between 2022 and 2024. A total of 1,056 rhinoplasty procedures were performed, including 432 thick-skinned cases, with a minimum follow-up of 12 months (range: 12–36 months). During open rhinoplasty, after completion of the structural framework and final tip shaping, a transseptal supratip control suture was placed to stabilize soft-tissue redraping and obliterate supratip dead space. The suture included a short, superficial A-bite from the undersurface of the skin–soft tissue envelope and was used to control supratip soft tissue through the septum without fixation to the upper lateral cartilage. Outcomes included supratip definition, supratip fullness/pollybeak deformity, and technique-related complications.

The supratip control suture was feasible and reproducible within the routine surgical workflow. In thick-skinned patients, improved supratip contour and enhanced tip definition were consistently observed throughout follow-up. Pollybeak deformity occurred in 2 cases (0.19%). During the early phase of implementation, localized epidermolysis occurred in 5 cases (0.47%) due to excessive suture tension and resolved with local wound care. Stable aesthetic outcomes were observed in all patients after a minimum of 12 months follow-up. No major long-term complications attributable to the technique were identified.

The supratip control suture is a simple and practical adjunct, particularly useful in thick-skinned rhinoplasty. By reducing supratip dead space and stabilizing soft-tissue redraping, it may improve supratip contour and tip definition and help prevent postoperative pollybeak deformity, with a low complication rate when appropriate suture tension is applied.