• The challenge of enduring tip projection is met with the use of a septal cartilage graft between the medial crura. With suturing, a "sandwich" is created composed of the two medial crura and the graft between them.
The sandwich can be trimmed as necessary, in accordance with the surgeon's taste requirements for good tip profile and projection. The graft allows much more projection than from the medial crura alone. We describe the Goldman technique of rim incisions, delivery of the lower lateral cartilages, bisection of each, and then creation of the sandwich.
The technique has been performed on more than 40 patients, in most of whom the results have remained successful more than six months postoperatively. The results indicate excellent fixation of the projected tip with maintenance of position, strength, and form.
The indications for this tip technique are the classical ones for medial crura projection, such as hypoplastic tip cartilages, short columella revision rhinoplasty, and most importantly, the increase of real projection not attained by simple rotation.
(Arch Otolaryngol 103:262-267, 1977)
