Decreasing nasal tip projection in rhinoplasty

Overview

Some noses need the tip brought back rather than pushed forward, which means working against the structures that hold the tip up. The authors review the history of these techniques, the anatomy of tip support, and how to tell a genuinely over projected tip from one that only looks that way. They then set out a suggested surgical approach.

Sections of note

• Review and technique article. No patient numbers, results, follow-up or complication rates are reported.
• The history and evolution of techniques for reducing tip projection are reviewed.
• Anatomy of the nasal tip is covered with emphasis on the tip support structures.
• The article distinguishes pseudo overprojection from true overprojection.
• Methods for diagnosing tip projection are reviewed.
• The recommended approach is incremental, with constant reassessment during surgery, keeping the most aggressive manoeuvres in reserve.
• Tip truncation is stated to be rarely if ever indicated and is often followed by contour deformity.

What it means for a patient

• A tip that looks too prominent is not always over projected; the surrounding structures can create that impression, and the correction differs.
• Small stepwise reduction is presented as safer than a single large manoeuvre.
• Aggressive cutting of the tip cartilage is associated with visible contour problems later.
• The abstract gives no outcome figures, so the claim that the approach is reliable is not supported by numbers here.

Why this paper matters

Reduction of the tip removes support, and lost support is what produces late collapse and irregularity, so the trend has moved toward conservative technique. What is unanswered is how much reduction is achievable without weakening the tip, and how the described approach compares with alternatives over time.

Terms

• Tip projection: how far the nasal tip stands out from the face.
• Overprojection: a tip that stands out further than the proportions of the face suit.
• Pseudo overprojection: a tip that appears too prominent because of surrounding structures rather than its own position.
• Tip support structures: the cartilage and attachments that hold the tip in position.
• Tip truncation: cutting across the tip cartilage to shorten it.
• Contour deformity: a visible irregularity in the outline of the nose.