The Saddle Projection Graft.

This paper and the accompanying video present a novel technique developed by the senior author to reliably control nasal tip projection and rotation with a midline cartilage graft that is nonbulky; easily reproducible; and conceptually intuitive. The saddle projection graft is a cartilage graft ∼5 by 15 mm in size fashioned from the nasal septum. A 15 blade is used to create a sagittal groove in the cartilage, which is then inset onto the anterior septal angle with the septum fitting within the sagittal groove. It is positioned to project anteriorly to the position of the desired nasal tip and the graft is inset with sutures. The tip is then unified upon this structurally stable unit. The midline position helps avoid the introduction of new deviation or asymmetry of the nasal tip. The cartilage dimensions do not demand a large stock of cartilage. The technique does not cause external valve obstruction or visibility. Most notably, the saddled position of the graft benefits from the direct support of the sturdy septal cartilage as it opposes the forces of scar maturation, resulting in predictable control of nasal tip projection and rotation.