Treatment of bulbous nasal tip is difficult. In the presence of thick,
inelastic skin, cartilaginous framework should be supported in specia
l areas. Many tip grafting techniques have been described but the resu
lts usually are not satisfactory. We developed a new tip grafting tech
nique to provide extra support and extra length to the nasal tip. The
graft is prepared from the septal cartilage and has an extended ''A''
appearance. The tip graft is supported with a columellar strut graft.
Both grafts are inserted into small separate pockets through separate
incisions. If necessary, the alar base is reduced with a modified Weir
technique. Fifty-two patients were treated with this technique over t
he last 3 years. Results were satisfactory in all patients without any
complications such as graft displacement, infection, or resorption. E
xtrasupported tip graft is an effective method in the treatment of bul
bous nasal tip with thick skin.