The Plunging Tip

Abstract

Background: The plunging tip is defined as a nasal deformity where the nasal tip descends or “plunges” during smiling. Objective: The authors prospectively measure a series of 25 patients with a focus on the anatomic changes of the nose before and after the patient smiles. Methods: Twenty-five women who presented for cosmetic primary rhinoplasty and complained of a plunging tip were included in the study. Three angles were measured on lateral view (tip angle, nasolabial angle, and columella inclination angle), along with changes in tip, subnasale, and alar crease. The Simon tip rotation angle (STRA) measured tip position in relation to the static tragus. The alar rim angle measured the angle of the alar rim at the nostril. Changes in static and smiling positions were compared. Results: Tip, nasolabial, and the columella inclination angles decreased between static and smiling positions by 10.9, 11.8, and 11.9 degrees, respectively. Tip position dropped by 0.9 mm, while the subnasale and alar crease junction elevated by 1.3 and 3.7 mm, respectively. The STRA, an angle independent of alar base movement, decreased by less than 1 degree. The alar rim angle increased by 9.9 degrees. Conclusions: Our data demonstrate that the nasal tip changes its position less than 1 mm with a full smile. The concept of a “plunging tip” is an optical illusion. In reality, the alar crease and subnasale elevate and the alar rim straightens, while the tip position changes minimally. Objectively, the tip moves less than 1 mm and less than 1 degree using the STRA. Level of Evidence: 3