Nasal Tip Management Utilizing the Open Approach

Abstract

■ As experience with tissue shrinkage and scar contracture has increased, many surgeons have moved away from more aggressive cartilage resection and scoring techniques toward the use of more conservative suture techniques for restructuring the tip cartilages.

■ Combining knowledge of the three dimensional nasal anatomy with a clear aesthetic understanding enables the surgeon to develop a clear surgical plan.

■ The surgeon can follow an algorithm for nasal tip management which allows for proper tip analysis and the determination of the techniques he/she can utilize to achieve the needed aesthetic goals.

■ In examining tip projection, the surgeon must understand the critical importance of examining tip projection in relation to the height of the radix.

■ Binding the medial crura together, to a columella strut, or to the caudal septum will ensure a solid foundation for the nasal tip and helps to avoid postoperative loss of nasal tip projection, which could eliminate any supratip break and may result in supratip fullness (pollybeak deformity).

■ If more tip projection is required than is provided by simple stabilization of the nasal base via the medial crura, the surgeon can look to additionally increase projection via either the Double Dome technique for minor increases or through the Lateral Crural Steal for greater projection.

■ In classic nasal tripod theory, a standard way to retrodisplace the tip is to shorten one or both of the legs of the tripod. When one shortens only the lateral crura or only the medial crura, a change in rotation will ensue. One can take advantage of this principle to accomplish both retrodisplacement as well as a change in rotation by selecting the proper technique.