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At the 1990 spring meeting of the American Academy of Facial Plastic and Reconstructive Surgery, Palm Beach, Fla, Dr Roger Crumley, University of California, Irvine, discussed the use of multiple cartilage grafts in open rhinoplasty. Emphasis was placed on using grafts for improving tip support and increasing the effective nasal length.
With regard to columellar struts, Dr Crumley suggests that longer grafts offer more tip support and can be used to enhance the nasolabial angle. Curvature in the cartilage graft is corrected by morselizing and placing a figure-of-eight suture lengthwise along the graft. The addition of infratip lobule tip grafts is helpful for increasing tip projection and nasal length. Care must be taken to sculpt the facets of the graft, as tip irregularities may otherwise occur on patients with thin skin. Sandwich grafts, two or more layers sutured or glued together, can achieve even greater tip projection. However, the author