Structure concept in nasal tip surgery

Abstract

When performing nasal tip surgery, a stable nasal base is critical in providing a good long-term outcome. Weakness in the nasal base can result in postoperative loss of nasal tip projection. Patients with a deficiency in the nasal base include those with inadequate tip projection, acute nasolabial angle, and dependency of the nasal tip. Maneuvers used to stabilize the nasal base include a sutured-in-place columellar strut, caudal extension graft, setting back and fixating the medial crura to an overly long caudal septum, or use of an extended columellar strut fixated to the periosteum about the nasal spine. Once the nasal base is stabilized, the lobule can be modified using domebinding sutures or a sutured-in-place tip graft. Use of these maneuvers can provide maximal tip projection with good tip contour. This article will discuss the principles behind the use of these techniques and discuss the nuances related to execution of the maneuvers.