Concepts and Techniques of Nasal Tip Surgery

Abstract

Background: Rhinoplasty is one of the most challenging procedures in plastic surgery. It is technically demanding, and tip surgery is an art form. It requires an in-depth knowledge of the complex three-dimensional anatomy of the nose, a complete understanding of its physiology, familiarity with the described techniques of nasal tip surgery, and a well-developed sense of aesthetics. Aim of the work: This article will describe different techniques used to create a refined, aesthetically pleasing nasal tip. Patients and methods: The patients in this study were selected from of Dr John Hodges, M.D' Office, Veterans Hospital, and Methodist hospital, USA, and Zagazig University hospital, Egypt. The study was carried out on 50 patients with different nasal tip deformities, who underwent rhinoplasty, they were 15 males and 35 females, their age ranging from 20 to 60 years old. Two approaches had been selected; an open approach had been done for 30% of our patients, and a closed approach had been done for 70% of our patients with different nasal tip techniques. Results: The results of this study for nasal tip refinement techniques demonstrated a decrease in reductive and irreversible techniques as cartilage transection, domal truncation , morselization, and scoring that had been done in 8% of our patients for each, with a concurrent increase in stabilizing, strengthening, and reorientation techniques as sutures and grafts techniques that had been done in 60% of our patients for each; so cartilage-dividing techniques and the vertical dome division are rarely necessary to reduce projection, broadness, and/or rotation of nasal tips, they have been used if suture and graft techniques do not achieve the adequate nasal tip definition. Conclusion: The simplest approach for refinement of nasal tip deformity that allows the planned surgical techniques to be performed without difficulty and cause the least disturbance to the tip's support, should be selected. Thus, we recommend the reversible, non destructive techniques as sutures and tip grafts for remodeling the tip deformities, with closed approach once indicated.