Tip Plasty Research Articles

Tip Surgery in Dorsal Preservation Rhinoplasty: The Effect of Modified Low Septal Strip Septoplasty on Tip Plasty.

The aim in tip surgery is to provide rotation, derotation, projection and deprojection. In this study, we aimed to show the effects of modified low septal strip septoplasty, septal extension graft, TIG technique and additional maneuvers on tip shape in dorsal preservation rhinoplasty (DPR) and to discuss our clinical results. One hundred eighty-nine patients who underwent DPR with modified low septal strip septoplasty between November 2021 and August 2023 were included in the study. Demographic data, complications, revision surgeries and follow-up periods of the patients were analyzed retrospectively. The mean age of the patients is 29.58±9.04 (17-65). The mean follow-up period was 14, 50±2,98 months. Complications were observed in 1.1% of the patients (n=2/189). Revision surgery was performed in all these patients. Residual hump in 2 were observed and dorsum rasping was performed under local anesthesia. No tip revision was performed on any patient. A strong tip fixation is achieved with the modified low septal septoplasty technique described in this publication, and when combined with septal extension graft, tongue in groove technique and other suture techniques, an effective and permanent tip plasty can be performed in DPR. 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 .

Rabbit model for the study of nasal tip plasty: a comparative cephalometric analysis after rhinoplasty

Background Open rhinoplasty and septoplasty have emerged as popular surgical techniques for both functional and aesthetic procedures. To study open rhinoplasty with or without septoplasty, the use of animals is necessary. However, no reports have been published on radiologic methods for evaluating rhinoplasty or nasal tip plasty in animals using cephalometry. In this study, a validated model of open rhinoplasty and septoplasty was utilized in rabbits to establish radiographic guidelines for assessing the degree of tip plasty in these animals.Methods Eight adult New Zealand rabbits were used to establish an autologous septal extension graft (SEG) model. The rabbits underwent concurrent submucosal septal resection and open rhinoplasty. The SEG was implanted using nasal septal cartilage. To evaluate the results of nasal tip plasty, lateral-view X-ray images were obtained preoperatively, as well as 2 days, 2 months, and 12 months postoperatively.Results This open rhinoplasty rabbit model appears to be a practical tool for studying open rhinoplasty and tip plasty, demonstrating statistically significant results following SEG implantation. Furthermore, it is suitable for training purposes, specifically for the submucosal resection of septal cartilage.Conclusions This study presents a statistical analysis of the long-term (1-year) postoperative results of SEG implantation, using experimental procedures like those utilized in humans. Through a cephalometric comparison of rabbit noses, the effect of various SEG and tip plasty methods on the rabbit nose can be objectively measured.

Prevention and Resolution of Silicone Implant-Related Problems in Secondary Rhinoplasty Using a Cross-Linked Human Acellular Dermal Matrix.

Silicone implant augmentation rhinoplasty along with various tip plasties are commonly performed in Asian patients, but a revision rhinoplasty is frequently required because of various problems. Secondary rhinoplasties are often performed using silicone, dermofat, costal cartilage block, or diced rib cartilage, but often result in unsatisfactory outcomes. This study assessed the surgical outcomes and complications of cross-linked acellular dermal matrix (ADM) as an alternative biological substitute for silicone implant in secondary rhinoplasty. The authors prospectively studied 56 patients with a minimum follow-up of 1 year among 104 patients who underwent secondary rhinoplasty in their clinic between January of 2015 and December of 2018. Silicone implant, capsule, and scar tissue removal; dorsal augmentation with ADM; and tip plasty using autogenous cartilage were performed for all of them. The results were assessed using the modified Rhinoplasty Outcome Evaluation, consisting of a 10-item questionnaire completed preoperatively, 6 months postoperatively, and over 1 year postoperatively. One infection and three cases of excessive resorption were noted, with no other major complications. The mean modified Rhinoplasty Outcome Evaluation score was 31.7 on preoperative evaluation, 77.3 at 6 months postoperatively, and 81.4 at 1 year postoperatively (mean difference, 45.6 and 49.7, respectively; P < 0.001). Various problems that occur after primary rhinoplasty using silicone implants can be resolved successfully with secondary rhinoplasty by dorsal augmentation using the cross-linked human ADM along with various nasal tip work using autogenous cartilage. Surgical outcome showed favorable resolution of contracture deformities, a low infection rate, firm fixation of the implant, good skin texture/thickness of the skin/soft-tissue envelope, and gain of desired height and dorsal line. Therapeutic, IV.

Changes in Nasal Tip Aesthetics Over Time Following Asian Tip Plasty.

This study aimed to evaluate the sequential postoperative changes in tip aesthetics, by evaluating the aesthetic performance of the septal extension graft with or without tip grafting. A total of 62 patients who underwent rhinoplasty with tip plasty were included. Using a three-dimensional scanner, we measured anthropometric aesthetic features of the nasal tip, including tip height, tip width, nasolabial angle, and columellar lobular angle. Preoperative and 1-month and 12-month postoperative anthropometric parameters were compared. The patients were grouped according to surgical techniques (i.e., septal extension only and septal extension plus tip grafting groups) and subtype of tip graft. The 1-month postoperative values of all four aesthetic features were significantly increased compared with the preoperative values. The tip height, tip width, and nasolabial angle at 12 months were significantly decreased compared with 1 month post-operation values, whereas the tip height and width were still greater than the preoperative values. No difference was found between 1 and 12 month values of columellar lobular angle. There were no differences in the degree of decrease in tip height, tip width, nasolabial angle, and columellar lobular angle between the septal extension graft only and septal extension graft plus tip graft groups. There were no differences in the tip graft by subtypes, single- and multi-layer tip grafts. Increased tip height, tip width, and widened nasolabial angle gained immediately after septal extension grafting surgery gradually decreased over the year regardless of addition of tip graft or tip grafting methods. 4 Laryngoscope, 134:678-683, 2024.

Section et/ou résection verticale des alaires en rhinoplastie

Nasal tip plasty is a real functional and aesthetical challenge in rhinoplasty. Many techniques have been described with different degrees of variability. The classic technique is the vertical division of the domes with section of the intermediate domes and directed healing without suture or cartilaginous grafting. The technique is based on an alar section or resection combined with a transdomal suture (STD) which allows control of the projection and rotation of the nasal tip.

Hybrid columellar strut using nasal crest bone of the maxilla and conchal cartilage for nasal tip stability in rhinoplasty for East Asian patients

Background Proper nasal tip projection and rotation are essential for an aesthetically pleasing nose. However, East Asians usually have thicker skin and underdeveloped nasal cartilage compared to Caucasians. Thus, techniques such as the septal extension graft, columellar strut graft, and L-shaped alloplastic implants have been introduced for additional nasal tip support and projection. However, no consensus exists regarding the optimal method.Methods A hybrid columellar strut made of an osteochondral graft recombined with the nasal crest of the maxilla and conchal cartilage was devised. In a cadaveric study, changes due to an external bending force of the hybrid strut and costal cartilage in the same dimension were measured. In a comparative study, we divided 20 subjects into two groups according to the material used for the columellar strut graft: a hybrid columellar strut (experimental group) and a double-layered conchal columellar strut (control group). Preoperative, 1-month postoperative, and 1-year postoperative anthropometric measurements were compared between groups.Results In the cadaveric study, the hybrid columellar strut showed superior mechanical strength. In the comparative study, the average 1-year postoperative change of the columellar labial angle was significantly smaller in the experimental group (–0.7°±1.16° vs. 2.2°±1.32°, P=0.015). The hybrid columellar strut showed superior postoperative nasal tip stability.Conclusions We devised a new hybrid columellar strut and confirmed its superior mechanical firmness and stability. Considering the suggested indications and contraindications, the hybrid columellar strut graft can be a new modality for tip plasty in East Asian rhinoplasty that can provide sufficient long-term nasal tip stability.

Tip Plasty: A New Modified Vertical Dome Division. “How I Do It?”

This manuscript aimed to report a new vertical dome division technique for the correction of different common nasal tip deformities. This technique is a novel approach and was never reported in the literature to the best of our knowledge. The technique was performed using an open approach on 337 patients presenting with a combination of different nasal tip deformities: overprojected nasal tips, drooping tips, asymmetical tips and wide domal arches. The included patients were operated on between 2012 and 2018, with a follow-up period of at least 1 year. A detailed description of the surgical steps used is provided. Surgery outcomes were predominately positive, with unsatisfactory results obtained only in 11 of the 212 included patients (125 patients were excluded from the study due to inadequate or no follow-up). Satisfactory results and minor complications were detected following this procedure. In conclusion the presented technique is an easy and effective method for the narrowing, uprotation, and deprojection of nasal tips as well as the correction of tip asymmetries mainly in thick-skin patients, with a low complication rate.

Application of Platelet-Rich Plasma in Nasal Tip Reconstruction with Medpor Prosthesis

Objective: To observe the effect of platelet-rich plasma (PRP) on reducing ear cartilage absorption and nasal tip complications after nasal tip plasty with medpor prosthesis. Methods: During the conventional medpor rhinoplasty, PRP was injected locally around the tip and columella of the nose with medpor material. The morphology of the nasal tip cartilage and the shape of the nasal tip were observed at least 1 year after the surgery, and the status of cartilage absorption was judged. The statistical differences between the control group and the experimental group were analyzed by χ²-test. Results: After observation for 1 year, a total of 71 cases underwent conventional medpor rhinoplasty, of which 21 cases had cartilage resorption, and 10 cases had a prominent shape of the nasal tip prosthesis that required repair; In the platelet-rich plasma treatment group, there were 18 cases, 1 case of cartilage absorption, and 0 case requiring repair. There are significant statistical differences in clinical practice. Conclusion: PRP can significantly reduce the absorption of ear cartilage, maintain the appearance of the nasal tip, and improve the satisfaction of patients with medpor prosthesis rhinoplasty.

Novel method for correcting cephalic rotation in Asian nasal tip plasty

To correct nasal tip cephalic rotation, SEG made of cartilage or Medpor are often used in rhinoplasty. These techniques require extensive experience for the surgeon, and not all patients can accept this procedure. In this research, we introduce a new method to correct nasal tip cephalic rotation that is relatively simple and rapid. Fifty-nine patients who had rhinoplasty using our scaffold were enrolled in the study between January 2020 and January 2021. The authors evaluated the change of nasolabial angel by photogrammetry using standardized clinical photogrammetric techniques. Patients' satisfaction regarding postoperative results was also surveyed. The mean postoperative follow-up duration was 12 months. No complication (infection, extrusion, and displacement) was happened in all patients. Analysis showed our scaffold can correct nasal tip cephalic rotation effectively (98.61±1.21 preoperatively and 89.68±0.99 postoperatively, P<0.0001). And the patient satisfaction rate is 98%. We constructed an integrated scaffold by simply folding and suturing a high-density polyethylene sheet (Su-Por) sheet to correct nasal tip cephalic rotation. Using the scaffold we designed, we did not need to alter the structure of the nasal septum, which reduced the operative duration and simplified the surgical procedure.

A New Method for Symmetrical Nasal Tip Plasty: The Role of the Location and Caudal Relations

A New Method for Symmetrical Nasal Tip Plasty: The Role of the Location and Caudal Relations

Long-Term Outcomes of Secondary Nasal Tip Plasty After Degradation of a Polycaprolactone (PCL) Mesh.

In secondary nasal tip plasty, it is often difficult to harvest appropriate septal extension grafts for sufficient tip projection. Therefore, studies using numerous alloplastic materials in rhinoplasty have been reported. This study aimed to evaluate the nasal tip change over time after tip plasty using a PCL mesh. We conducted a retrospective study of 86 Asian patients who received secondary tip plasty by septal extension grafting with a PCL mesh as a batten graft. Patient demographics and surgical outcomes were examined. The outcome variables were nasolabial angle, nasofrontal angle and Goode ratio. Measurements were performed with photographs obtained at short-term (postoperative 4-6 months) and long-term (more than postoperative 24 months) follow-ups. Aesthetic outcomes and safety were assessed using the Global Aesthetic Improvement Scale. Among 86 patients, 56 had a long-term follow-up. The mean age was 33.33 years, and the male-to-female ratio was 17.44:82.56. The nasolabial and nasofrontal angles did not change significantly between the short-term and long-term follow-ups. The Goode ratio, which is a useful tool to evaluate nasal projection, was decreased by 5.00%. Nevertheless, all patients were satisfied, and the long-term aesthetic outcomes were improved in 54 (96.4%) patients. There were two cases (2.33%) of complications, including one infection and one case of PCL-mesh protrusion. The present study demonstrated the usefulness and safety of PCL meshes when used in septal extension grafts as batten grafts. Although biodegradation seems to affect the nasal projection, PCL is still useful in secondary tip plasty along with other alloplastic materials. 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 .

Correction of Severe Secondary Cleft Lip Nasal Deformity.

The lower lateral cartilages (LLCs) are key elements for alar and tip support. Repositioning of both LLCs is an effective procedure for correcting a laterally spreading dome of LLCs and drooping nasal tip in cleft lip nasal deformity (CLND). The alar contour graft has become an essential component of rhinoplasty for correcting the concave or collapsed and retracted alar. Herein, onlay cartilage graft was combined with nasal tip plasty to correct hypoplastic cleft lateral crus or alar rim retraction, and with columella strut to obtain better aesthetic outcomes in patients with severe CLND. Seven patients with severe secondary unilateral CLND, including hypoplastic cleft lateral crus or alar rim retraction, underwent rhinoplasty from October 2013 to April 2020. Both LLCs were isolated and repositioned approximated medially using tip suture technique combined with columella strut. A septal cartilage onlay graft was applied on the hypoplastic cleft lateral crus. Cartilage graft on the nasal tip was performed to further project and enhance the nasal tip. Photogrammetric evaluation of the operated patients and statistical analysis of the obtained data were performed. The average age at operation was 23.5 (range: 17-36) years. The follow-up period was 6-36 (mean, 14.3) months. All patients were enrolled by photogrammetric evaluation. Height of the medial nostril and short axis of the nostril on the cleft side were increased with a statistical significance of P < 0.05, indicating that depressed ala on the cleft side, which is a feature of CLND, was corrected similar to that of the noncleft side. The alar contour cartilage graft, as an effective adjunctive technique, improves the alar margin, prevents the alar rim from collapsing, and provides supports to the cleft-side alar rim. It can be a prophylactic measure to prevent postoperative retraction in patients with weakened LLCs. Lower lateral cartilage repositioning, columellar strut, and nasal tip plasty are useful for correcting severe secondary unilateral CLND.

Effectiveness of cross-linked human acellular dermal matrix in primary and revision augmentation rhinoplasty

Among the materials used for dorsal augmentation rhinoplasty (DAR), cross-linked human acellular dermal matrix (ADM) has been claimed for its low risk of infection and extrusion. The aim of this study was to compare the effectiveness of ADM in subjects undergoing primary versus revision dorsal augmentation rhinoplasties. Using a retrospective cohort study design, the investigators enrolled a cohort set of DAR patients operated by a single surgeon during a 65-month interval. The predictor variable was the treatment group (primary or revision DAR). The main outcome variables were postoperative changes with regard to the degree of augmentation (ratio of the dorsal height [DH] and radix height [RH] to the nasal length) and patients' and surgeons' satisfaction with the aesthetic and functional results. Other study variables were grouped into the following categories: demographic, surgical, and pathological. Descriptive, uni-, and bivariate statistics were computed using P ≤ 0.05 as a cutoff value. The study cohort comprised 145 subjects (75.2% with primary DAR; 39.3% females) with a mean age of 30.7 ± 9.4 years (range, 19-58). DAR was linked to the significant changes in DH and RH in both the treatment groups. Comparison of the two groups revealed that there was no significant difference in DH and RH between both the groups. Surgeons' and patients' satisfaction rates were comparable between the two surgery groups, neither of which experienced serious complications. Microscopic findings of the removed ADM showed abundant collagen tissue with newly formed vessels without signs of foreign body reaction. Despite significant differences in patient characteristics (age; number of osteotomy, tip plasty, and hump reduction surgeries), the results of this study suggest that ADM can be used in both primary and revision DAR, with minimal complications.

Correction of a Secondary Bilateral Cleft Lip Nasal Deformity in Adults Using Repositioning of Both Lower Lateral Cartilages and Nasal Tip Plasty Through an Open Bilateral Reverse-U Incision.

Correcting a secondary bilateral cleft lip nasal deformity is very complex with many challenges due to its complexity. This study presents the surgical results after correcting a secondary bilateral cleft lip nasal deformity using isolation and repositioning of the lower lateral cartilages, the columellar strut, and an onlay graft on the nasal tip. Eighteen patients who had bilateral cleft lip nasal deformities and who had surgery performed between September 2013 and December 2019 were included in this study. The age of the patients ranged between 19 and 52 years. Open rhinoplasty with bilateral reverse-U incision was performed. The lower lateral cartilages were isolated and repositioned. Nasal tip support is provided using a columellar strut with a septal cartilage or Medpor strut. In the vertical component of the nasal tip, a conchal cartilage graft was used. The mean follow-up period was 2 years (ranging from 1 to 6 years). Fourteen of the 18 patients underwent photogrammetric evaluation. After surgery, the projection of the nasal tip and angle increased, but nasal bridge length decreased. The columella-labial angle significantly increased by 10.1% after surgery which was statistically significant (P < 0.05). The angle between the nostril axes significantly decreased by 46.2% postoperatively and also reached statistical significance (P < 0.05), indicating that the displaced alar base and lower nostril sill improved and the major axis of the nostril changed more vertically oblique. All patients were pleased with their surgical results. The proposed technique was highly effective in correcting secondary bilateral cleft lip nasal deformities in adults.

Moderate and Major Saddle Nose; the Causes and Correction

Back ground: Saddle nose deformity is of different types and classifications, and there are several surgical approaches and grafting materials selected by the surgeons for the correction. Objective: Study the causes, surgical steps, and outcomes of correction of moderate and major saddle nose by the author using autologous iliac crest bone graft. Patients and method: A retrospective case study of 34 patients, with saddle nose, corrected by dorsal onlay graft and columella strut harvested from autologous iliac crest bone via endo-nasal approach rhinoplasty, at Salah-Elden governorate during period from Jan. 2008- Dec. 2015. Results: The common cause of saddle nose was septal abscess 16 patients (47%), nasal trauma 7 patients (20.6%), then congenital and iatrogenic causes. The cosmetic results all 34 patients (100%) get good results and satisfied for the patient‟s and the surgeon, with follow-up surgeon satisfaction were in 32 patients (94%). Functional improvement was (94.7%). Conclusions: 1.Autologous iliac crest bone graft is good graft material for augmentation of saddle nose deformity. 2. Optimum cosmetic outcomes achieved by doing osteotomies and in fracture of nasal bones, tip plasty, and alar base resection.3. The procedure used for graft taken from iliac crest bone is relatively safe with low complications.

Double Layer Lateral Crural Perichondrial Flap for Coverage and Stabilization of Tip Graft.

Tip plasty is the most important step of rhinoplasty. To achieve symmetrical cartilages with ideal tip rotation, projection and supratip break many techniques were defined. Besides suture techniques, tip grafts still maintain their importance and widely used among surgeons. However, graft visibility and distortion are the main drawbacks of this technique. In this study double-layered lateral crural perichondrial flap technique was introduced to prevent graft visibility and distortion as a novel technique. A total of 16 patients who underwent rhinoplasty with this novel technique were enrolled in this retrospective study. Patient satisfaction was assessed with Rhinoplasty Outcome Evaluation Questionnaire (ROE-Q). Graft visibility and asymmetry of tip defining point as an indicator of graft distortion were evaluated by two independent Plastic, Reconstructive and Aesthetic surgeons. Pre and postoperative photographs were taken and used for evaluation. A three-point Likert scale was used for assessment. Cohen's Kappa statistic and percent agreement test were usedtotest inter-rater reliability RESULTS: The mean follow-up time was 15 months (ranging between 12 and 19 months). According to the ROE-Q score, the mean total preoperative score was 6,25 and the mean total postoperative score was 18,06 (p<0,05). No or minimal evident graft visibility and asymmetry of tip defining point was observed in 12 patients and 10 patients, respectively. Mild evident graft visibility was observed in only 1 patient with thin skin. Severe evident graft visibility or asymmetry of tip defining point was not observed in none of the patients. The double-layer crural perichondrial flap was an effective and sufficient method for preventing graft visibility and graft distortion. Features like easy and fast flap elevation, no additional comorbidity, being autologous tissue and sufficient flap length and thickness make this technique valuable and useful. 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 .

The Onlay Rotated Flap (ORF): An Original Technique for Nasal Tip Plasty.

The reshaping of the nasal tip in rhinoplasty according to the expectations of the patient and the surgeon is called tip plasty. in this article, the onlay rotated flap (ORF) is presented as a new technique for reshaping, supporting, and projecting the nasal tip without any resection or grafting. Thirty-two patients (26 female and 6 male) were included in the study retrospectively. Primary rhinoplasty with ORF was performed to all patients. The follow-up period was between 9 and 12months. The nasal tip projection (NTP) with Goode method and nasal tip rotation (NTR) according to nasolabial angle were calculated in standardized preoperative and postoperative(6th month) photographs with image J. SPSS Version 21.0 was used for statistical analysis. There were no complications resulting from our procedure. There were no visible tip flaps, no distortion, no asymmetry, and no alar retraction. Revision surgery was not required in any patient. The preoperative and postoperative means of nasolabial angle (Mean ± SD) were 92.06 ± 7.73° and 99.71 ± 6.06°, respectively. The preoperative and postoperative means of NTP (Mean ± SD) were 0.535 ± 0.041 and 0.57 ± 0.386, respectively. The postoperative nasal tip rotation and NTP values of the ORF procedure were found to be statistically significantly higher than the preoperative values (P < 0.05). The ORF technique is another alternative for achieving adequate nasal tip definition and projection and has many advantages and very successful postoperative results. The alar retraction was not encountered in our technique and this is the superior aspect of our technique over similar methods described in the literature.

Aesthetic Nasal Lobule Correction Using a Three-Dimensional Printed Polycaprolactone Implant.

Nasal tip plasty is a surgery that determines important rhinoplasty outcomes. A variety of autologous and alloplastic implants are utilized in this procedure, including 1 synthetic material known as polycaprolactone (PCL). This study provides background on the ready-made three-dimensional printed PCL implant for nasal lobule correction, before discussing the usefulness and effectiveness of the implant. A total of 23 patients who visited our hospital between January 2018 and January 2020 were evaluated in this study. We used 3 types of PCL implant to get an ideal shape for the nasal tip: tipball (globular shape), droneball (rugby ball shape), and dumbbell (dumbbell shape). The authors compared nasolabial angle and tip projection at the preoperative and postoperative period via photographic anthropometric analysis. In 4 patients, we also examined the dead space between the implant and soft tissue via ultrasonography. The follow-up period averaged 9.5 months and no serious complications were found after surgery. The nasolabial angle and tip projection had an average postoperative increase of 6.4° and 0.044, respectively. Ultrasonography revealed the attachment of the implant at the insertion site and no dead space was found. This is the first attempt to apply a ready-made three-dimensional printed PCL implant to a nasal lobule correction procedure. As the implant was easy to use and showed good results, it may be useful for aesthetic purposes in future nasal tip plasty procedures.

Alar Lifting Technique for the Correction of Tilted Alar Base.

Frequently, a tilted alar base characterized by a discrepant level of the nostril sill and alar insertion on both sides is encountered in patients seeking rhinoplasty. Herein, we report our surgical technique and outcome of alar lifting technique for correcting tilted alar base. The medical records of 18 patients with alar base asymmetry who underwent rhinoplasty using the alar lift technique between January 2014 and December 2019 were retrospectively reviewed. The alar lifting procedure included a pointed ellipse-shaped excision of vestibular skin just inside the nostril sill, and sutures using 5-0 monocryl. Surgical outcomes were determined on the frontal view of facial images by comparing pre- and postoperative angles formed by a line drawn parallel to the lowermost part of both pupils and a line connecting the lowermost part of the base of the ala. Of 18 patients, 12 (66.7%) were men, and 6 (33.3%) were women. The mean age was 31.8 years (range 16-55). The alar lifting technique was performed on the left side in 12 cases and on the right side in 6 cases, and concurrent tip plasty was performed in 15 (83.3%) cases. The mean alar tilt angle was 3.9 preoperatively and 2.0 postoperatively. The mean angle change was 1.9°. Sixteen (88.9%) out of 18 patients had decreased alar level discrepancy. No patient had complications. Our alar lifting technique can serve as a useful adjunctive technique in rhinoplasty in patients with a tilted ala. 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 .

Columellar Strut in Correcting the Recurrent Vestibular Stenosis.

Management of vestibular stenosis is always a challenge in rhinology, especially for patients with complete vestibular stenosis. Tip plasty (with columella strut) can be supplemented to the primary surgery, can ensure good functional and cosmetic outcomes in patients with complete vestibular stenosis.