Facial Plast Surg 2012; 28(02): 158-165
DOI: 10.1055/s-0032-1309293
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Nasal Tip Projection: Nuances in Understanding, Assessment, and Modification

Simon Robinson
1   Wakefield Sinus and Facial Plastic Centre, Wellington, New Zealand
,
Mona Thornton
2   Royal Victoria Eye and Ear Hospital, Dublin, Ireland
› Author Affiliations
Further Information

Publication History

Publication Date:
06 May 2012 (online)

Abstract

Nasal tip projection refers to the anteroposterior extent to which the nasal tip is separated from the facial surface at the level of the alar-facial groove. Although its relevance in rhinoplasty is obvious, it is important to understand that changes to the projection of the nasal tip affect nasal tip rotation, dorsal height, and nasofacial aesthetic harmony. The following article discusses the subjective and objective assessment of nasal tip projection, the relevant anatomy, and tools to plan ways of modifying aspects of tip projection. Several different techniques will then be described in detail, along with relevant clinical illustrations.

 
  • References

  • 1 Larrabee Jr WF. The tripod concept. Arch Otolaryngol Head Neck Surg 1989; 115: 1168-1169
  • 2 Anderson JR. The dynamics of rhinoplasty, in Proceedings of the Ninth International Congress in Otorhinoloryngology. International Congress Series 206. Amsterdam: Excerpta Medica; 1969
  • 3 Adamson PA, Funk E. Nasal tip dynamics. Facial Plast Surg Clin North Am 2009; 17: 29-40 , vi
  • 4 Goode RL. Personal communication, 1983. In: Powell N, Humphrey B, , eds. Proportions of the asthetic face. New York: Thieme-Stratton Inc.; 1984
  • 5 Baum SJ. Introduction. J Ear, Nose & Throat 1982; 61: 426-428
  • 6 Powell N, Hophries B. Proportions of the aesthetic face. New York: Thieme-Stratton; 1984
  • 7 Leach J. Aesthetics and the Hispanic rhinoplasty. Laryngoscope 2002; 112: 1903-1916
  • 8 Simons R. Nasal tip projection, ptosis, and supratip thickening. J Ear, Nose & Throat 1982; 61: 44
  • 9 Ingels K, Orhan KS. Measurement of preoperative and postoperative nasal tip projection and rotation. Arch Facial Plast Surg 2006; 8: 411-415
  • 10 Goldman IB. Surgical tips on the nasal tip. Eye Ear Nose Throat Mon 1954; 33: 583-586
  • 11 Vuyk HD, Olde Kalter P. Open septorhinoplasty. Experiences in 200 patients. Rhinology 1993; 31: 175-182
  • 12 Sadeghi M, Saedi B, Arvin Sazegar A, Amiri M. The role of columellar struts to gain and maintain tip projection and rotation: a randomized blinded trial. Am J Rhinol Allergy 2009; 23: e47-e50
  • 13 Guyuron B. Footplates of the medial crura. Plast Reconstr Surg 1998; 101: 1359-1363
  • 14 Simons RL. Vertical dome division in rhinoplasty. Otolaryngol Clin North Am 1987; 20: 785-786
  • 15 Adamson PA, McGraw-Wall BL, Morrow TA , et al. Vertical dome division in open rhinoplasty. An update on indications, techniques, and results. Arch Otolaryngol Head & Neck Surg 1994; 120: 373-380
  • 16 Kridel RW, Konior RJ, Shumrick KA, Wright WK. Advances in nasal tip surgery. The lateral crural steal. Arch Otolaryngol Head Neck Surg 1989; 115: 1206-1212
  • 17 Foda HM, Kridel RW. Lateral crural steal and lateral crural overlay: an objective evaluation. Arch Otolaryngol Head Neck Surg 1999; 125: 1365-1370
  • 18 Lipsett EM. A new approach surgery of the lower cartilaginous vault. AMA Arch Otolaryngol 1959; 70: 42-47
  • 19 Guyuron B. Footplates of the medial crura. Plast Reconstr Surg 1998; 101: 1359-1363
  • 20 Spina V, Kamakura L, Psillakis J. A new method for correction of the prominent nasal tip. Plast Reconstr Surg 1973; 51: 416-420
  • 21 McCollough EG, English JL. A new twist in nasal tip surgery. An alternative to the Goldman tip for the wide or bulbous lobule. Arch Otolaryngol 1985; 111: 524-529
  • 22 Tardy Jr ME, Cheng E. Transdomal sutur refinement of the nasal tip: longterm outcomes. Facial Plast Surg 1993; 9: 275-284
  • 23 Daniel RK. Rhinoplasty: Creating an aesthetic tip. A preliminary report. Plast Reconstr Surg 1987; 80: 775-783
  • 24 Mustarde JC. The correction of prominent ears using simple mattress sutures. Br J Plast Surg 1963; 16: 170-178
  • 25 Furnas DW. Correction of prominent ears by conchamastoid sutures. Plast Reconstr Surg 1968; 42: 189-193
  • 26 Adamson PA, Tropper GJ, McGraw BL. Otoplasty. In: Krause CJ, , ed. Aesthetic Facial Surgery. Philadelphia, PA: Lippincott; 1991
  • 27 Jang T-Y, Choi Y-S, Jung YG, Kim KT, Kim KS, Choi JS. Effect of nasal tip surgery on Asian noses using the transdomal suture technique. Aesthetic Plast Surg 2007; 31: 174-178
  • 28 Kridel RW, Konior RJ. Controlled nasal tip rotation via the lateral crural overlay technique. Arch Otolaryngol Head Neck Surg 1991; 117: 411-415
  • 29 Foda HM, Kridel RW. Lateral crural steal and lateral crural overlay: an objective evaluation. Arch Otolaryngol Head Neck Surg 1999; 125: 1365-1370
  • 30 Webster RC. Advances in surgery of the tip: intact rim cartilage techniques and the tip-columella-lip esthetic complex. Otolaryngol Clin North Am 1975; 8: 615-644
  • 31 Wise JB, Becker SS, Sparano A, Steiger J, Becker DG. Intermediate crural overlay in rhinoplasty: a deprojection technique that shortens the medial leg of the tripod without lengthening the nose. Arch Facial Plast Surg 2006; 8: 240-244
  • 32 Bafaqeeh SA. Open rhinoplasty: effectiveness of different tripplasty techniques to increase nasal tip projection. Am J Otolaryngol 2000; 21: 231-237
  • 33 Kuran I, Tümerdem B, Tosun U, Yildiz K. Evaluation of the effects of tip-binding sutures and cartilaginous grafts on tip projection and rotation. Plast Reconstr Surg 2005; 116: 282-288
  • 34 Joseph J. Nasenplastik und Sonstige Geischtsplastik Nebst Mammaplastik. Leipzig, Germany: Curt Kabitzsch; 1931
  • 35 Safian J. Corrective Rhinoplastic Surgery. New York, NY: P Hoeber; 1935
  • 36 Foda HM. Alar setback technique: a controlled method of nasal tip deprojection. Arch Otolaryngol Head Neck Surg 2001; 127: 1341-1346
  • 37 Soliemanzadeh P, Kridel RW. Nasal tip overprojection: algorithm of surgical deprojection techniques and introduction of medial crural overlay. Arch Facial Plast Surg 2005; 7: 374-380