Vertical Dome Division in Rhinoplasty

Abstract

One of the most difficult problems in aesthetic rhinoplasty is in obtaining and maintaining adequate tip projection. Over 40 years ago, Dr. Irving Goldman described his technique of vertically incising the tip cartilages lateral to the domes and then bringing the medial crura together to increase tip projection. Tip grafting has been used more and more as the means of obtaining greater tip projection. However, difficulties with proper placement of these grafts, rotation, and displacement, as well as procuring graft material, have made these procedures somewhat more difficult for the surgeon and patient alike. In a retrospective review, 145 patients who underwent primary rhinoplasty with vertical division of the lower lateral cartilages in order to increase tip projection were compared with 41 patients who underwent tip grafting to achieve the same goal. Similar results were obtained in both groups; however, the vertical dome division patients were found to have fewer complications.