An Alternative Fixation Technique for Onlay Cartilage Grafts in the Nasal Dorsum: A Surgical Innovation

Onlay cartilage grafts are widely used to correct dorsal contour irregularities and enhance nasal projection. However, conventional fixation techniques often present limitations, such as graft instability, displacement, and warping. We present an alternative fixation technique designed to offer reliable stabilization of dorsal onlay grafts. The method involves creating a linear groove in the bony dorsum and a corresponding notch in the graft, which is then secured using a small cartilage peg–a 'peg‑and‑groove' anchoring mechanism. This design provides primary mechanical stability against graft displacement and warping, addressing a key limitation of conventional techniques. Developed for patients requiring significant dorsal augmentation, its preliminary application has demonstrated reliable graft position and smooth dorsal contours at 6‑month follow‑up. Requiring moderate surgical experience, this technique offers a simple and reproducible solution for secure dorsal augmentation.