Nasal tip grafting

Abstract

James W. Fox IV, MD Rollin K. Daniel, MD Stephen W. Perkins, MD Nicolas Tabbal, MD Dr. Fox: Rhinoplasty is the most difficult operation in aesthetic plastic surgery, and I think we would all agree that the most difficult part of the procedure involves the tip of the nose, our subject for this panel. The first patient is a 16-year-old teenager with the familiar complaint, “I hate my nose, it is too big and blobby” (Figure 1). Doctor Tabbal, what would you recommend to this young woman with thick skin? Figure 1 This 16-year-old teenager complains, “I hate my nose; it is too big and too blobby.” Dr. Tabbal: What strikes me is the disproportion in her nasal balance. The nasal lobule is significantly more prominent than the upper half of the nose, which is somewhat narrow. The nasal tip is slightly deviated to the left and is quite heavy looking with effaced lower lateral cartilages. I suspect that the tip volume is primarily related to the quality of the soft tissues rather than the volume or shape of the alar cartilages. In order to achieve the desired tip refinement in this patient, I would rely on a reduction of the volume of the alar cartilages, combined with centralization of the tip and enhancement of the tip defining points through use of the open rhinoplasty approach and tip suture techniques. I see no need for cartilage grafting in this case because tip projection appears to be quite adequate. Dr. Fox: Dr. Perkins, does the width of this patient's nose at the base need to be addressed with regard to getting the tip into balance? Dr. Perkins: Looking at her frontal view, she has fairly wide-set eyes. Her inner canthi are wide enough to accommodate the width of her alar base, which is …