Defining the infratip lobule in rhinoplasty: anatomy, pathogenesis of abnormalities, and correction using an algorithmic approach

Rohrich RJ, Liu JH.

What this paper says

Using a review of primary rhinoplasties and a cadaver model, the authors classify the causes of an over-projecting infratip lobule into four intrinsic types and one extrinsic type and give a step-by-step algorithm for correcting it; the abstract reports no patient counts.

Overview

The infratip lobule is the part of the tip just below its highest point, above the columella. When it sticks out too far the lower nose looks heavy or hanging. The authors set out why this happens, mainly deformities of the middle crus of the tip cartilage, and present a classification and surgical sequence.

Sections of note

Retrospective review of primary rhinoplasties combined with a cadaver model; case examples presented; level of evidence V.
Intrinsic causes: long middle crus, wide middle crus, lower lateral cartilage malposition, and combinations.
Extrinsic cause: a prominent septum.
Sequence: correct extrinsic causes first, then work from medial to lateral, from the medial crus to the lateral crus.
Final refinement with transdomal sutures; the endpoint is reached when the upper and lower edges of the lower lateral cartilage lie in the same plane.
No outcome figures, follow-up or complications are stated.

What it means for a patient

A heavy or hanging tip can have several different causes in the cartilage, and the fix depends on which one is present.
The plan is to correct the septum first if it is pushing the tip out, then adjust the tip cartilages in order.
This is a classification and technique paper from one group, without measured results.

Why this paper matters

The infratip lobule had little dedicated literature before this paper. The classification gives surgeons a shared language for a subtle tip problem. Whether the algorithm produces consistent results in other hands is not tested.

Terms

Infratip lobule: the part of the tip between its highest point and the top of the columella.
Middle crus: the segment of the tip cartilage between the medial crus in the columella and the lateral crus along the nostril.
Lower lateral cartilage: the paired tip cartilages that shape the tip and nostrils.
Malposition: tip cartilages that sit rotated upward from their normal orientation.
Transdomal suture: a stitch through the highest point of each tip cartilage that narrows and shapes it.
Level V evidence: expert opinion or a technique description without comparative data.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“Excess infratip lobule projection is often the result of deformities of the middle crus and lower lateral cartilage. The causes and correction of excess projection have not been well described. The classification of the deformities causing excess infratip lobule projection is defined and a surgical algorithm for…”

Excerpt; the full abstract is on PubMed.