Cephalic resection is a technique that can help achieve refinement or "narrowing" of the nasal tip. In this technique, a resection of a portion of the tip cartilage along the upper edge is undertaken. Known by surgeons as cephalic resection, this technique is an-other important and useful method for refining the bulbous tip (Fig. 24).

When performing a cephalic resection, rhinoplasty surgeons must carefully judge how much to take and how much to leave behind. It is critical that the sur­geon not take too much. There are general guidelines of how much is too much, but each patient is different, and the strength of each patient's cartilage must be carefully considered. If a patient has thin, soft, weak cartilage, very little if any cephalic resection should be undertaken.

Tip grafts can be useful in achieving a number of different effects, depending upon how the surgeon shapes and places the graft. A tip graft is typically made from the patient's own cartilage, preferably taken from the nasal septum during septoplasty. Tip grafts can help create additional nasal tip refinement. Depending upon its placement, a tip graft can also be helpful in projecting the nose, in lengthening the nose, or both. Tip grafts can also be helpful in revision rhinoplasty (Fig. 25).

FIGURE 21. (c,d) Spreader grafts can provide important support of the middle third of the nose in certain types of patients. Patients who may need the additional support of spreader grafts include those undergoing hump reduction and who have small nasal bones and long upper lateral cartilages.

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