Nasal Tip Recontouring in Primary Rhinoplasty

Abstract

Objective

Surgery of the nasal tip is a particular challenging aspect of rhinoplasty. We describe a surgical concept in nasal tip surgery that is novel in certain aspects. It combines maneuvers that are typically reserved for the open approach with the minimally invasive concept of endonasal rhinoplasty.

Methods

Integral to the concept are the complete dissection and delivery of the lateral crus, repositioning of the dome, placement of alar strut grafts that extend far medially, and lateral advancement of the lateral crus.

Results

This concept of nasal tip recontouring through the endonasal complete release approach is illustrated in detail. Representative cases are displayed, and outcomes in a population of 100 consecutive young female primary rhinoplasty patients are presented.

Conclusions

The concept allows for excellent cosmetic and functional outcomes through a minimally invasive approach with preservation of a naturally soft nasal tip. Patient comfort is maximized by reduced swelling, avoidance of nasal packing, and obviation of external incisions.

Gassner and coauthors introduce an holistic approach to analysis and reconfiguration of the lower lateral cartilages (LLCs). It includes repositioning of the domal angle and lateral crus while preserving the structural integrity of the LLC complex. The approach is endonasal yet allows for very extensive correction of the nasal tip.