Abstract
The authors associate the projection of the nasal tip to hypertrophy of the alar cartilages and, more specifically, of their medial branches. The heavy, blobby, or bulbous nose is caused by an increase of the columellar-alar angle of the alar cartilages, and bears no relationship to the cephalometric nasal index. Moreover, the bulbous nose usually has excess fatty tissue present in the tip of the nose. The projecting tip may be corrected by excising a rectangular or quadrangular segment from the medial branches of the alar cartilages, or by resecting the cupula of the alar cartilages, including a small or large segment of its medial branch, in order to obtain the desired effect, namely, to lower the tip and decrease the columellar-alar angle. The nasal index remains unchanged. If in addition, the tip of the nose is bulbous, the fatty tissue should be removed at the same time.
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