Narrowing the Wide Tip via Endonasal Approach

Abstract

Rhinoplasty is arguably the most complex and intricate surgery performed by facial plastic surgeons. Nasal tip refinement of a broad nasal tip has remained the most challenging part of rhinoplasty as sophisticated techniques are critical to achieve aesthetically pleasing and structurally sound nasal tips that can withstand the contractile forces of healing. Successful tip refinement relies on an in-depth preoperative and intraoperative understanding of the patient's nasal anatomy, well developed arsenal of techniques, the experience of the surgeon, and the aesthetic desires of the patient. Although the approach to gain access to the nasal tip so as to successfully reshape the tip has been a topic of debate over many years, the aim of this article is to outline and demonstrate how the broad nasal tip can be successfully recontoured through an endonasal approach using nondestructive techniques that have been effectively used in open rhinoplasty. We believe that there continues to be a place for endonasal tip rhinoplasty especially in this era in which patients desire less invasive procedures with shorter healing time.

Correction and prevention of tip asymmetries, bossae, and alar retraction

“…As trends in modern rhinoplasty shift toward emphasizing minimal intervention for maximal function and aesthetic benefits, rhinoplasty surgeons must be familiar with minimally invasive approaches to nasal tip refinement. The endonasal approach can offer many advantages that abide by these modern rhinoplasty principles, as it offers preservation of nasal tip anatomy by minimizing external incisions and limiting direct dissection of nasal tip structures [59][60][61] . The minimally invasive nature of this approach not only limits the visibility of scars but also significantly reduces postoperative swelling and bruising, enhancing patient recovery times [62,63] .…”