02/02/2026
CRURAL CANTILEVER TIP, DELTA GRAFT, and INVERTED DELTA GRAFT
The three-dimensional architecture of the final tip has progressively changed as a result of innovative solutions introduced by colleagues worldwide.
The strategy we currently perform and propose is the outcome of multiple refinements—some established, some newly introduced—that together lead to a stable and long-lasting tip result.
This strategy is based on two grafts and several key principles:
Inverted Delta Graft
Anchored to the septal extension graft (SEG)—or, in selected cases, to a long W-ASA—this graft allows definitive control of tip projection and rotation by stabilizing the natural domes. This is not a spanning/eversion graft - just an anchor point for the natural domes.
Delta Graft
Anchored in the “W area,” slightly cephalic to the caudal upper lateral cartilages (ULCs), this graft allows precise positioning and shaping of the lateral crus, including control of shape, divergence, and eversion. This represents an evolution of the Gunter / .rohrich “alar spreader graft concept”.
Release of Soft Tissues
Soft tissues, including ligamentous structures and densifications, maintain the original anatomy that we must modify.
Release of the Lateral Crus
Complete release of the lateral crus—including its tail—from the skin and mucosa is crucial to avoid cartilage “memory.” Many technically sound maneuvers on the lateral crus fail in the medium term because the tail is not adequately released. Several colleagues have long adopted this approach, with special mention to
Avoidance of New Dome Creation
Creating new domes introduces new tension. Instead, the three-dimensional anatomy of the lower lateral cartilages (LLCs) should be repositioned as a single structural unit, preserving the original domes while relocating them to a new, stable position.
Floating-articulated ALAR RIM grafts must be used
We hope this strategy will serve as an additional option for managing the consistently challenging outcomes associated with nasal tip surgery in rhinoplasty.
Ps- This is a technical post addressed to doctors and not to patients
