Extended shield tip columella grafting is an essential tool in structure, ethnic, custom, revision and reconstructive rhinoplasties, whenever the tip columella complex needs to be partially, subtotally or totally redesigned, providing the location, prominence, shape, size, angle or specific custom look desired by the patient or deemed technically required by the surgeon, from a subtle change up to a totally brand new custom made tip; common indications are the poorly defined tip, tip bossing, overly rotated tip, the droopy tip, aging tip, tip asymmetries, ethnic noses, revision of poor results, feminization cases, sunken columella, upturned noses, etc.
This kind of extended shield tip and columella grafting has different shapes like pentagonal, shield, extended to the columella shield, extended to supratip, etc, depending on the effect sought and the peculiarities of the tip and the overlying skin as well as tip support; additionally the graft can be hard, flat and with ridges should the skin be thick or the effect wished ambitious, or can be smoothly beveled, curvy, pliable and integrated when the skin is thin or the change expected a subtle one, one or multilayered, with or without combination with columella strut, being the ideal donor sites the nasal septum, ear concha and the rib, with or without temporalis fascia camouflage grafting to hide its visibility in thin skin noses.
It is considered a highly demanding technique of high difficulty, long time consuming in the operating room and pretty much artistic in terms of its versatility, allowing full deployment of creativity reshaping noses.
This gesture can be done by either closed or open approach rhinoplasties, notwithstanding the open approach is a must of safety, reliability and precision for its execution.
Patients warning: only highly experienced surgeons who have underwent optimal training and have performed already a large number of closed and open approach structure and non structure rhinoplasties should execute high end rhinoplasty cases, should they feel capable and comfortable with the challenge.