Deprojection of the nasal tip in revision rhinoplasty

Overview

A tip that projects too far from the face after surgery can have several origins. Sometimes the original anatomy was never corrected; sometimes the bridge was lowered so much that a normal tip now looks too big; sometimes healing changed the shape. The authors argue that the revision surgeon needs a range of techniques and offer a decision sequence for choosing among them.

Sections of note

• Technique review with an algorithm; no patient series, results or complications are stated in the abstract.
• Causes of overprojection in revision: under-addressed anatomic variations, iatrogenic causes including overresection of the dorsum, and the healing process.
• Management is described as very difficult.
• The surgeon must have multiple techniques for the different causes.
• The specific deprojection techniques are not listed in the abstract.

What it means for a patient

• A tip that looks too prominent after rhinoplasty may be a tip problem or a bridge problem, and the fix differs.
• Reducing tip projection in a previously operated nose is among the harder revisions because support structures have already been altered.
• The article is expert guidance without outcome data.

Why this paper matters

Deprojection requires shortening the tip's support without collapsing it, and prior surgery leaves less to work with. This article, in a Facial Plastic Surgery revision issue, organizes the approach by cause. How well each technique holds up over time is not reported.

Terms

• Tip projection: how far the tip stands out from the face.
• Overprojection: a tip that projects too far.
• Deprojection: surgery to reduce tip projection.
• Iatrogenic: caused by previous medical or surgical treatment.
• Dorsum: the bridge of the nose.
• Algorithm: a step-by-step decision plan for choosing which maneuvers to use.