Droopy Tip Research Articles

The Effectiveness of Rein Flap Technique in the Cosmetic Outcomes of Rhinoplasty

Background: The beauty of nasal tip is very important in septorhinoplasty surgeries. Unstable tip rotation may lead some problems in the outcome of this surgery or performing a repair surgery. Hence, using an appropriate method to save the tip rotation for the long term is considered. Materials and Methods: We studied 30 patients who underwent rhinoplasty in Imam Khomeini Hospital Complex of Tehran and Razi Hospital of Tehran and divided them equally into two groups of rein (case) and septocolumellar (control), randomly. Then, we evaluated the rotation and projection of the nasal tip (nasolabial, columellar-labial, and nasofacial angles) after 2 weeks and 6 months of the surgery. Results: In both groups, 80% and 20% of the patients were female and male, respectively. The reduction of the nasal projection (columellar-labial and nasofacial angles) and nasal rotation (nasolabial angle) was significant in both groups during 6 months after the surgery (P > 0.001) that showed reduction in the nasal projection and rotation after 6 months in both group. This reduction was not significant in the nasofacial and columellar-labial angles (nasal projection) among two groups. However, in the case of nasolabial, we found less reduction in the case group that explains significant relation (P = 0.03). Discussion: Using rein flap can be used as a proper way to save the tip rotation in the long term and could be used in the patients with droopy tip noses. Conclusion: Using rein flap in nasal tissue seems to be effective in providing a stable rotation and projection. This method can be considered as a good option for providing proper projection and rotation.

A Novel Modification of Tongue in Groove Technique (Auto-Septal Projection Graft) in Rhinoplasty.

Derotation of the nasal tip with narrow nasolabial angle is a common nasal deformity that leads to a long nose appearance, named drooping nose. In these patients, there are various techniques described to fix droopy tip and to achieve a desirable nasal tip rotation such as caudal septal extension graft, extended columellar strut graft, tongue in groove, columellar strut graft, and tip rotation sutures. This study aimed to evaluate changes in nasal tip support after modified tongue-in-groove technique (auto-septal projection graft). Forty-two patients who underwent a primary open approach septorhinoplasty using the modified tongue-in-groove technique between June 2017 and March 2019 were retrospectively analyzed. Postoperative and preoperative photographs were analyzed, and nasolabial angle and the nasal tip projection ratio were recorded and compared before and average of 17.3 months after the surgery. Forty-two patients (33 female and 9 male) were included the study. The mean nasolabial angle was 85.7° preoperatively and 99.3° postoperatively. The nasal tip projection ratio was 0.60 preoperatively and 0.64 postoperatively. Both the tip rotation and the tip projection increased significantly after the modified tongue in groove (p<0.05). It seems that modified tongue-in-groove method (auto-septal projection graft) is an effective technique in maintaining tip projection and rotation in rhinoplasty and safe method to correct droopy nasal tip in selected cases. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Lateral crural overlay of the lower lateral cartilages, a technique to enhance nasal tip rotation, and reduce projection in the droopy nasal tip

Background and objective: Tip plasty is one of the most common feats encountered by the Aesthetic Rhinoplasty Surgeon. Tip rotation, with or without tip deprojection, is one of the challenging problems that face the surgeon, with many overwhelming techniques to correct rotation and projection of the nasal tip, including, but not limited to overlapping of the lateral crural cartilages. This study aimed to assess the efficacy and reliability of the technique of the lateral crural overlay of the lower lateral cartilages in enhancing nasal tip rotation and decreasing nasal tip projection. Methods: This prospective study included 64 patients, who underwent primary, and secondary, open Rhinoplasty, with nasal droopy tip and nasal tip true overprojection problems. They have been treated in Sulaimaniyah Hospital for Burn and Plastic Surgery, and from Private Hospitals in Sulaimaniyah city. The age range was 18-34 years. Forty nine patients were female, the rest of the patients were male. They have been treated, primarily, for the tip drooping and to a lesser extent for nasal tip overprojection, by the senior author, with Lateral Crural Cartilages Overlay. The study conducted from April 2012 to January 2016. The patients, postoperatively, were followed up for up to one year. Goode ratio and Nasofacial angle deducted from real time photographs have been used to evaluate the amount of rotation and deprojection of the nasal tip. Results: Overlapping of the Lateral Crura of the Lower Lateral Cartilages, is a safe and reasonable technic in achieving nasal tip rotation, with or without, projection reduction, of the droopy nose. The operative time and dissection are very encouraging. Complications associated with this technic are very negligible, with high patient satisfaction rates. Only five rhinoplasty patient has been revised for the sake of tip rotation/projection, in this series of cases. No Major complications happened in the collumellar skin incision or the nasal rim infracartilagenous incisions, nor in the undermined nasal vestibular skin separated from the undersurface of the Lower Lateral Cartilages. Conclusion: Overlapping, or overlaying, of the lateral crura of the lower lateral cartilages, is a reasonable technique to enhance tip rotation, and reduction of the tip projection, by medial crural steal and telescoping of the incised lower lateral cartilages, with good aesthetic and functional outcomes, with reasonable complication rates, very low revision rate, and high patient satisfaction rates.

Barrel Roll Technique for the Correction of Long and Concave Lateral Crura

To describe the barrel roll technique that is capable of concurrently correcting 2 associated deformities--overprojection and ptosis of the nasal tip. Thirty-two patients with concavity of the upper section of 1 or both lateral crura combined with a droopy tip were treated from January 1, 2005, through December 31, 2007. In all cases, the barrel roll technique was used, which involves rotating the lateral crus by 180° on its major axis so that the concavity is transformed into convexity, and carrying out lateral crural overlay to correct the overprojection concurrently. All the patients displayed functional and aesthetic improvement by correcting the droopy tip and concavity of the lateral crura. Revision was necessary in 1 case of monolateral concavity. The comparison of preoperative and postoperative rhinomanometric data showed significant improvement of nasal airway resistance. A combination of the overlay technique and rotation of a portion of the lateral crus on its axis is capable of concurrently correcting serious functional problems and aesthetic defects of the nasal tip. The open approach is essential for perfect positioning of the mobilized cartilaginous segments and ensuring stable results over time.

Barrel Roll Technique for the Correction of Long and Concave Lateral Crura

To describe the barrel roll technique that is capable of concurrently correcting 2 associated deformities—overprojection and ptosis of the nasal tip. Thirty-two patients with concavity of the upper section of 1 or both lateral crura combined with a droopy tip were treated from January 1, 2005, through December 31, 2007. In all cases, the barrel roll technique was used, which involves rotating the lateral crus by 180° on its major axis so that the concavity is transformed into convexity, and carrying out lateral crural overlay to correct the overprojection concurrently. All the patients displayed functional and aesthetic improvement by correcting the droopy tip and concavity of the lateral crura. Revision was necessary in 1 case of monolateral concavity. The comparison of preoperative and postoperative rhinomanometric data showed significant improvement of nasal airway resistance. A combination of the overlay technique and rotation of a portion of the lateral crus on its axis is capable of concurrently correcting serious functional problems and aesthetic defects of the nasal tip. The open approach is essential for perfect positioning of the mobilized cartilaginous segments and ensuring stable results over time.

Rhinoplasty for Middle Eastern Noses

Rhinoplasty remains one of the most challenging operations, as exemplified in the Middle Eastern patient. The ill-defined, droopy tip, wide and high dorsum, and thick skin envelope mandate meticulous attention to preoperative evaluation and efficacious yet safe surgical maneuvers. The authors provide a systematic approach to evaluation and improvement of surgical outcomes in this patient population. A retrospective, 3-year review identified patients of Middle Eastern heritage who underwent primary rhinoplasty and those who did not but had nasal photographs. Photographs and operative records (when applicable) were reviewed. Specific nasal characteristics, component-directed surgical techniques, and aesthetic outcomes were delineated. The Middle Eastern nose has a combination of specific nasal traits, with some variability, including thick/sebaceous skin (excess fibrofatty tissue), high/wide dorsum with cartilaginous and bony humps, ill-defined nasal tip, weak/thin lateral crura relative to the skin envelope, nostril-tip imbalance, acute nasolabial and columellar-labial angles, and a droopy/hyperdynamic nasal tip. An aggressive yet nondestructive surgical approach to address the nasal imbalance often requires soft-tissue debulking, significant cartilaginous framework modification (with augmentation/strengthening), tip refinement/rotation/projection, low osteotomies, and depressor septi nasi muscle treatment. The most common postoperative defects were related to soft-tissue scarring, thickened skin envelope, dorsum irregularities, and prolonged edema in the supratip/tip region. It is critical to improve the strength of the cartilaginous framework with respect to the thick, noncontractile skin/soft-tissue envelope, particularly when moderate to large dorsal reduction is required. A multitude of surgical maneuvers are often necessary to address all the salient characteristics of the Middle Eastern nose and to produce the desired aesthetic result.

Management of severe tip ptosis in closed rhinoplasty: the horizontal columellar strut

Tip ptosis is a relatively common nasal deformity, with an incidence as high as 72% in rhinoplasty patients. Different techniques were described for surgical correction of the droopy tip, such as the lateral crural steel, the lateral crural overlay, the tongue-in-groove technique and others. Most authors agreed that an external rhinoplasty approach is necessary for effectively conducting the alar cartilage-modifying techniques mentioned above. In this article we challenge this paradigm and introduce an efficient method for aesthetic correction of severe tip ptosis through an internal rhinoplasty approach. Twenty-three patients with severe ptosis of the nasal tip were operated on by the senior author (MH) between 2000 and 2005 using the described technique. After carrying out the necessary manoeuvres to achieve the desired tip rotation (reduction of cephalic border of alar cartilages, modification of the caudal septum, reduction of upper lateral cartilages), the desired tip position was maintained with the horizontal columellar strut, whose initial operative description appears here. The desired rotation and projection were maintained in all but three patients over the first year after the surgery. In three patients we observed some loss of tip projection after 1 year. We did not witness complications directly related to the horizontal columellar strut. The horizontal columellar strut is an efficient tool for stabilising the corrected position of a severely ptotic nasal tip. We recommend adding the horizontal columellar strut to the array of available rhinoplasty techniques.

Mini Spreader Grafts: A New Technique Associated with Reshaping of the Nasal Tip

Reshaping of the nasal tip by excision of a strip of cartilage from the cephalic portion of the lateral crura is a commonly used procedure. This surgical technique is not completely free of risk, above all when associated with hump excision, as is often the case. It can lead to incompetence of the internal nasal valve and thus to postoperative respiratory disorders. The author proposes a new surgical technique capable of preventing these problems and improving the degree of nasal tip rotation, where necessary. The method combines resection of the cephalic portion of the lateral crura with its attachment on either side of the dorsal septum as two "mini spreader grafts." Forty patients were treated by means of this technique. Rhinomanometric data demonstrate an improvement in total mean nasal airflow, and no worsening was registered in any case. Correction of droopy tip was also achieved with optimal cephalic rotation of the tip. Although small in size, the grafts are very important in functional terms in that they restore a physiologic angle in the area of the internal nasal valve between the septum and the upper lateral cartilages. The preservation of a fibromucous connection between the grafts and the two lateral crura from which they are taken has an aesthetic effect. To this end, it is sufficient to secure the two mini spreader grafts to the septum in a more cephalic position to obtain a greater degree of rotation of the tip complex.

Management of the Droopy Tip: A Comparison of Three Alar Cartilage–Modifying Techniques; Hossam M. T. Foda, M.D.

Received for publication May 19, 2003. Mark B. Constantian, M.D. 19 Tyler Street Nashua, N.H. 03060 [email protected]