The Princess and the Pea Graft—A Solid Cartilaginous Tip Graft for Noses with Thick Skin Envelope

Introduction: Thick skin-soft tissue envelope (SSTE) and weak cartilage make nasal tip definition challenging in many Asian rhinoplasty patients. Objectives & Hypotheses: We aimed to assess whether the Princess and the Pea (PP) graft-a solid, conical costal cartilage tip graft-can improve tip projection and definition in thick-SSTE patients. We hypothesized that it would yield reliable aesthetic and functional results with minimal complications. Study Design: Prospective clinical study with 12-month postoperative follow-up. Methods: Sixty patients of East, South, and Southeast Asian descent received a PP graft anchored to the lower lateral cartilages. Outcomes were measured using SCHNOS and a 5-point Likert satisfaction scale. Results: Mean satisfaction was 4.5/5, average SCHNOS score 0.54, and no graft-related complications occurred. Conclusion: The PP graft is a safe and effective method for enhancing nasal tip projection and definition in thick-SSTE patients.