The Infratip Strut Graft

Introduction: The infratip strut graft (ISG) is a trapezoid-shaped graft for the infratip area. The graft is used in combination with tongue-in-groove (TIG). The combination ISG-TIG is indicated in patients with weak lower lateral cartilages or a heavy soft tissue envelope. The hybrid technique shortens the nose with the control of the TIG and provides stability and refinement in the nasal tip. Methods: The ISG can be placed through an endonasal or external approach rhinoplasty. After one or two TIG sutures the ISG can be placed in the groove of the infratip lobule reaching as far as the tip defining points. A temporary needle stabilized the graft between the medial crura. The graft was fixated in between the medial crura of the infratip lobule with 2-3 absorbable mattress sutures. Results: We used the TIG-ISG hybrid technique in >50 patients. In conjunction to TIG the ISG is helpful to increase the stability of the infratip lobule and tip defining points to refine the nasal tip. Conclusions: The TIG-ISG technique is a proven technique to support and stabilize the medial crura in patients with weak lower lateral cartilages, a thick skin soft tissue envelope or a low caudal septal border in both primary and revision cases.