Onlay tip grafting is an essential tool in structure, ethnic, custom, revision and reconstructive rhinoplasties, whenever the tip needs to be partially redesigned, providing the prominence, shape or size desired by the patient or deemed technically required by the surgeon, from a subtle to moderate changes; common indications are the poorly defined tip, the droopy tip, aging tip, ethnic noses, revision of poor results, etc.
This kind of onlay tip grafting has different shapes like square or rectangular, 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 in which case would be known as umbrella graft, 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.