Open structure rhinoplasty for precise control of nasal tip projection

Abstract

Most techniques that control tip projection involve relatively aggressive maneuvers that can compromise the integrity of the nasal structure by dividing major support mechanisms, or dramatically alter the shape of the nasal tip by cutting the lower lateral cartilage and re-orienting the domes. Decreased tip support can result in an iatrogenic loss in tip projection that may require compensatory over-reduction of the nasal dorsum. This series of events may result in a blunted nose with a poorly defined dorsum. Open structure rhinoplasty techniques emphasize preservation or reconstitution of major support mechanisms to attain a natural-looking nose that will not deteriorate with time. This technique uses the open (external) approach to the nose, sutured-in-place columellar strut, advanced lateral crural manipulation, and a sutured-in-place tip graft to provide tip projection, support, and a bidomal tip configuration. This article discusses the theory, major technical points, and use of this technique for precise control of tip projection.