Abstract
The external rhinoplasty approach continues to stimulate both the development of new ways to sculpture the nasal tip and thoughtful reevaluation of older ones. The open technique encourages careful study of tip anatomy and allows precise and direct manipulation of the lower lateral cartilages. Though still preferred by most surgeons only in a select number of cases, the external rhinoplasty has encouraged a trend toward more repositioning and augmentation of the nasal tip framework. Part of this trend is a renewed interest in the vertical division of the alar domes and the prototype of this technique first described by Dr Irving Goldman over 30 years ago. In theArchives, Dr Goldman detailed his approach to the mesial crura in nasal tip reconstruction as follows: Circumferential incisions are made within the lower margins of the nostrils, extending caudally and downward and including the posterior part of the columella for about one
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