Improving Projection of the Nasal Tip in Primary Endonasal Rhinoplasty

Overview

The authors state that gaining, improving and maintaining tip projection is one of the essential elements of successful endonasal rhinoplasty. Early technique consisted of removing the upper margin of the tip cartilages from inside, reducing the cartilage and bone hump, and cutting the nasal bones. Some of those simple operations still look good decades later, while many are conspicuous for lacking tip projection.

Sections of note

• Technique article; the abstract reports no patient numbers, no outcomes, no complication rates and no follow up.
• The polly beak deformity is described as the hallmark of inadequate tip projection after rhinoplasty.
• Early technique is described as intracartilaginous excision of the upper margin of the lower lateral cartilages, hump reduction and bone cuts.
• The authors attribute inconsistent results to inattention to the structural integrity and anatomical position of the lower lateral cartilages.
• The senior author uses a combination of suture, strut and cartilage grafting techniques.
• Those are tailored to each patient's individual anatomy.

What it means for a patient

• Polly beak refers to a fullness above the tip that makes the profile look beak like, and it usually reflects a tip that sits too low rather than a bridge that is too high.
• Modern technique supports the tip cartilages rather than only trimming them.
• This is expert opinion and historical account. No results are reported.

Why this paper matters

Loss of tip projection was the recurring failure of early reduction rhinoplasty and drove the shift toward structural support. This article traces that history and describes the corrective approach. It provides no data on how often the described techniques succeed.

Terms

• Tip projection: how far the tip of the nose stands out from the face.
• Polly beak deformity: a fullness above the tip giving the profile a beak like outline.
• Lower lateral cartilages: the paired cartilages forming the nasal tip.
• Endonasal rhinoplasty: surgery through incisions inside the nose only.
• Intracartilaginous excision: cutting through and removing part of a cartilage from within.