The TRICK-TIP Rhinoplasty: Tip of the Nose Preservation Using the Combined Synergy of Open and Closed Approaches

Villegas-Alzate F.

PubMed 38483551 Publisher (DOI)Free full text (PMC)

What this paper says

In 120 patients, a hybrid approach that cuts the columella low but does not lift the tip skin, raising the whole mobile nose as a three-layer flap, gave high FACE-Q satisfaction and 102 independent raters scored the columellar scar as nearly invisible (1.35 of 5).

Overview

Villegas-Alzate describes TRICK-TIP (Transcolumellar and Inter Cartilaginous Keystoning with Tip preservation): a low stair-step columellar incision plus transmembranous and intercartilaginous incisions, with no skin dissection over the columella or tip. The mobile nose lifts as a three-layered flap giving wide access to the pyramid and septum. Tip changes are done retrograde; a columellar strut is often placed. Outcomes were four FACE-Q questionnaires and photograph ratings by 102 independent raters.

Sections of note

120 patients; high satisfaction and few adverse effects on FACE-Q.
Independent raters scored "overall nose result" 3.6 of 5.
Deformity scores (1 = absent, 5 = disfigurement): nostril 1.84, soft triangle 1.73, columellar scar 1.35.
No complications; revisions infrequent.
Level of Evidence V.

What it means for a patient

The method aims for the visibility of open surgery while keeping the tip's skin attachments intact, which should reduce tip swelling and soft-triangle problems.
Independent raters found the scar and rim deformities minimal.
It is a single surgeon's technique and series.

Why this paper matters

It is one of several recent attempts to combine open access with preservation of the tip's soft-tissue envelope. Limits: single surgeon, no comparison group, photographic ratings by lay or unspecified raters.

Terms

Transcolumellar incision: the external cut across the columella used in open rhinoplasty.
Intercartilaginous incision: an internal cut between the upper and lower lateral cartilages.
Soft triangle: the thin skin fold at the nostril apex, easily deformed by surgery.
Columellar strut: a cartilage post supporting the tip.
FACE-Q: a validated patient-reported questionnaire for facial aesthetic procedures.

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

Abstract

Background: This study introduces and assesses the outcomes of a novel rhinoplasty technique, TRICK-TIP (Transcolumellar and Inter Cartilaginous Keystoning with Tip preservation), employing a combined open and closed approach with tip anatomy conservation and structured tip support.

Methods: The procedure involves a low stairstep columellar sectioning, followed by transmembranous and intercartilaginous incisions without skin dissection in the columella or tip. Elevating the entire mobile nose as a three-layered flap provides extensive access to the entire nasal pyramid and septum. Tip modifications, including retrograde cephalic cartilage resection and supratip skin thinning, are performed based on individual cases. A key columellar strut is frequently used, initially sutured in the interdomal space and then turned down for height adjustment and final fixation. Interdomal sutures, supratip sutures, and alar resection are implemented as needed.

Results: One hundred twenty patients participated, with high satisfaction and a low frequency of adverse effects reported using four FACE-Q™ questionnaires. One hundred and two independent raters evaluated pre and postoperative photographs, scoring "overall nose result" as 3.6 out of 5, with minimal or absent nostril deformities (1.84), soft triangle deformities (1.73), and columellar external scar deformity/visibility (1.35) where 1 is the absence of the deformity and 5 is disfigurement. Complications were absent, and revisions were infrequent.

Conclusions: The combined benefits of the wide-open approach, shortened surgery duration, and nasal tip preservation contribute to outcome optimization. TRICK-TIP rhinoplasty is characterized by simplicity, enabling targeted modifications, preventing soft triangle and rim complications, and facilitating essential tip support while maintaining favorable results. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).