Nasal tip recontouring in primary rhinoplasty: the endonasal complete release approach

Gassner HG, Mueller-Vogt U, Strutz J, Kuehnel T.

What this paper says

The authors describe a closed-approach tip technique that fully frees and delivers the tip cartilages, repositions the domes and adds long alar strut grafts, and present outcomes in 100 consecutive young women having primary rhinoplasty; the abstract gives no outcome figures.

Overview

Detailed tip work is usually done through the open approach with an external incision. The authors combine open-style maneuvers with the closed approach: the lateral crus is completely dissected free and brought out through the nostril, the dome is repositioned, strut grafts extending far toward the midline are placed, and the lateral crus is advanced outward.

Sections of note

Technique concept with illustrated steps and representative cases.
Core maneuvers: complete dissection and delivery of the lateral crus, dome repositioning, alar strut grafts extending far medially, lateral advancement of the lateral crus.
Outcomes presented for 100 consecutive young female primary rhinoplasty patients; the abstract states no satisfaction, revision or complication numbers.
Stated advantages: excellent cosmetic and functional results, a naturally soft tip, less swelling, no nasal packing and no external incision.

What it means for a patient

Substantial tip reshaping and support grafts can be placed through incisions inside the nose, avoiding a scar on the columella.
The authors report a softer tip and less swelling than with open surgery, but the abstract gives no measurements.
The series is young women only, from one center, without a comparison group.

Why this paper matters

It argues that the closed approach can deliver structural tip surgery, countering the trend toward routine open rhinoplasty. Numbers to support the claimed advantages are absent from the abstract.

Terms

Endonasal approach: rhinoplasty through incisions hidden inside the nostrils.
Lateral crus: the side arm of the tip cartilage running along the nostril.
Delivery: pulling the tip cartilage out through the nostril incision so it can be worked on directly.
Dome: the highest point of each tip cartilage.
Alar strut graft: a cartilage strip placed under the lateral crus to support and reshape it.
Nasal packing: gauze placed inside the nostrils after surgery.

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

From the abstract

“Surgery of the nasal tip is a particular challenging aspect of rhinoplasty. We describe a surgical concept in nasal tip surgery that is novel in certain aspects. It combines maneuvers that are typically reserved for the open approach with the minimally invasive concept of endonasal rhinoplasty. Methods: Integral to…”

Excerpt; the full abstract is on PubMed.