Algorithm for the Treatment of Tip Malformation Combining a Clinical Qualitative Assessment and Specific Closed-Rhinoplasty Techniques Based on Retrospective Analysis of Pellegrini's Fellows 40 Years' Experience

Scattolin A, D'Ascanio L, Galzignato PF, De Luca P, Orlando N, Ralli M, Di Stadio A.

PubMed 39187588 Publisher (DOI)Free full text (PMC)

What this paper says

From 19,643 closed primary rhinoplasties over 40 years, the Italian authors derived a tip-surgery algorithm based on volume, projection and rotation, with 88.7% full satisfaction and 12.3% minor revision over 20 years of follow-up.

Overview

This is the largest single-school rhinoplasty series in this collection. Patients (15,266 women, 4,377 men) treated from 1979 to 2019 by closed rhinoplasty for tip defects were assessed by a volume-projection-rotation (VPR) framework, and the surgical choices, long-term results and complications were analysed to produce an algorithm.

Sections of note

19,643 Caucasian patients, primary closed rhinoplasty, 1979-2019.
22% with minimal defects treated by a non-delivery approach; 78% with significant tip malformation by a delivery approach.
67% needing major reduction of projection were treated with tip-interrupting techniques.
88.7% declared full satisfaction; 12.3% needed minor revision over 20 years.
Level of Evidence III.

What it means for a patient

Closed tip surgery, done systematically, gave durable satisfaction in a very large series.
About 1 in 8 patients had a minor touch-up over two decades, a realistic long-term figure.
The results reflect one school's techniques on Caucasian noses; satisfaction was self-declared.

Why this paper matters

Its scale and 40-year span are unmatched, and it documents that dome-dividing (interrupting) techniques were used in most major projection reductions with acceptable long-term results. Limits: retrospective, single school, unvalidated satisfaction measure.

Terms

Closed rhinoplasty: all incisions inside the nostrils.
Delivery approach: bringing the tip cartilages out through the nostril incisions to work on them directly.
Non-delivery approach: modifying tip cartilage in place without exteriorising it.
Tip-interrupting technique: cutting through the tip cartilage (dome division) to reduce projection.
Volume-projection-rotation (VPR): the authors' three-axis tip assessment.

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

Abstract

Background: The aesthetic importance of nasal tip and the complexity of its surgical correction make the surgery of this area one of the most fascinating facial surgical procedures. Despite description of different sculpturing techniques to correct nasal tip defects, this surgery remains one of the most discussed and challenging aesthetic procedures.

Objectives: The objective of this study was to define an algorithm of treatment for nasal tip surgery based on 40-year experience on Caucasian patients evaluated by our proposed clinical qualitative assessment, who were treated by closed rhinoplasty.

Methods: We retrospectively reviewed 19,643 Caucasian patients (15,266 females and 4,377 males) who underwent primary closed rhinoplasty from 1979 to 2019 due to different tip defects. The patients were evaluated by volume projection rotation (VPR) assessment. The surgical indications options, long-term aesthetic results and complications were analysed.

Results: 22% patients with minimal nasal defects were treated by non-delivery approach and 78% patients with important tip malformation by delivery approach. In all cases, the surgery was performed to reduce tip volume and modify tip projection and rotation based on the specific nasal defects. 67% patients, who needed important reduction of tip projection, were treated by tip-interrupting techniques. 88.7% patients declared full satisfaction after surgery, and only 12.3% needed a requiring minor revision surgery during the 20 years follow-up.

Conclusion: The proposed algorithm may be a useful tool to plan surgery. The use of an adequate technique depending on the evaluation of volume, projection and rotation may guarantee higher patients satisfaction and a stable long-term aesthetic result.

Level Of Evidence Iii: 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).