Incisor Show-based Selection of Tip Augmentation Rhinoplasty Technique

Overview

The authors state that most rhinoplasty candidates show too little of their upper teeth when smiling, and that tip maneuvers such as a columellar strut can shift lip position. The article sets out the senior author's algorithm for selecting a tip augmentation technique based on that relationship, drawn from 44 years of practice. Five scenarios are described.

Sections of note

• Article type: algorithm and technique selection article. No patient numbers or outcome data are reported.
• Short columella with inadequate incisor show: bilateral extended spreader grafts plus a columellar strut with a tapered posterior portion, supporting the medial crura more forward.
• Optimal lip to incisor relationship: a columellar strut with a tapered posterior end fixed to the septum, to avoid changing the smile.
• Excessive gum show: a columellar strut without tapering or with a wider posterior end, fixed to the septum, which pushes the upper lip downward.
• The remaining two of the five scenarios are not described in the abstract.
• Stated principle: preoperative upper lip position when smiling should be integral to choosing the tip technique.

What it means for a patient

• Tip surgery can change the smile by moving the upper lip, and the direction depends on how the support graft is shaped and fixed.
• The shape of the back end of the strut is the lever: tapered to avoid moving the lip, wider to push it down when too much gum shows.
• The algorithm is one surgeon's system based on observation, not a tested protocol.
• The abstract carries no findings. It reports no patient numbers, measurements or outcomes.

Why this paper matters

The interaction between tip support and the smile is easy to overlook because rhinoplasty is planned from static photographs. Turning that interaction into an explicit selection rule makes it part of routine planning. Whether following the algorithm measurably protects or improves the smile has not been tested.

Terms

• Incisor show: how much of the upper front teeth is visible when smiling.
• Columellar strut: a cartilage post placed between the nostrils to support the tip.
• Extended spreader graft: a long cartilage strip alongside the septum reaching past the bridge to support the tip.
• Medial crura: the inner arms of the tip cartilages, running down toward the nostril base.
• Gummy smile: excessive gum visible above the upper teeth when smiling.