ArticleAesthetic plastic surgery2026
The Lower Lateral Cartilage-Spanning Spring Graft (The Gullwing Effect).
Article in Aesthetic plastic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundBulbous nasal tip surgery due to lateral-crural pseudo-malposition in medium-to-thick skin with weak cartilage is often challenging. Suture-only maneuvers may not reliably maintain the lateral-crural resting angle in such anatomy.
methodsA modification of the lateral crural spanning graft was used in 17 consecutive primary rhinoplasty patients with bulbous tip deformity due to lateral-crural pseudo-malposition. A single-layer septal cartilage strip (lower lateral cartilage spanning spring graft, LCSSG) was integrated into a septal extension graft (SEG) through a slit, forming a cross-shaped construct. The LCSSG limbs rested on the cephalic borders of the lateral crura and were fixed with 5-0 PDS, creating a spring that reoriented the lateral crura and reinforced the alar rim. Demographics, skin thickness, fixation variant, follow-up, complications, and rhinoplasty outcome evaluation (ROE) scores were recorded.
resultsSeventeen primary cases (13 women, 4 men; mean age 32 years) with medium-to-thick skin (11 thick, 6 medium) were followed for a mean of 16.2 ± 5.4 months (range, 9-26). Mean ROE improved from 12.6 ± 3.1 (5-16) preoperatively to 19.4 ± 2.0 (13-22) postoperatively, with a mean ΔROE of 6.8 ± 3.4 (3-14). In the early suture-only group (n = 4), ΔROE was 6.8 ± 4.8 (3-13) and two patients (50%) developed mild supratip fullness with slight rim retraction. In the slit-anchored group (n = 13), ΔROE was 6.8 ± 3.1 (3-14) and no complications occurred.
conclusionsThe LCSSG-SEG construct provides a dynamic spring that reorients the lateral crus and supports the alar rim in primary cases with lateral-crural pseudo-malposition and medium-to-thick skin. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ."
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