Nasal Tip Deprojection in Rhinoplasty

Datta S, Tugertimur B, Hanna SA, Goote P, Morris M, Mattos D, Reish RG.

What this paper says

Among 447 patients whose overprojecting nasal tips were brought back using a combination of three maneuvers, 3.8 percent required revision and 1.8 percent needed antibiotics over a mean 22.4 months.

Overview

A tip that projects too far can result from a person's own anatomy or from a previous operation. Reliably reducing that projection is the aim of deprojection rhinoplasty. The authors reviewed 2003 rhinoplasty cases from one surgeon's practice between July 2014 and June 2022, selecting those involving tip deprojection with at least a year of follow up.

Sections of note

Design: retrospective chart review, single senior surgeon. Level of evidence therapeutic IV.
447 of 2003 reviewed cases met the inclusion criteria.
Mean age 32.1 years, with 409 women. 291 cases were primary rhinoplasties.
Mean follow up: 22.4 months.
8 patients, 1.8 percent, required empiric antibiotics; 17 patients, 3.8 percent, required a further operation.
The technique combines three elements: removing part of the medial crura, a lateral crural steal, and a columellar strut graft.
Note the abstract states the technique is designed to decrease nasal tip deprojection, which appears to invert the intended meaning.

What it means for a patient

Reducing tip projection is technically harder than increasing it, since the framework has to be shortened while keeping it stable.
The three maneuvers work together: shortening the inner cartilage arms, borrowing length from the outer arms, and adding a post to hold the new position.
Revision was needed in roughly 1 in 26 patients, and the follow up of nearly two years covers the period when a tip is most likely to shift.
Limits: retrospective, single surgeon, no comparison group, and outcomes limited to revision and infection rates with no appearance or satisfaction measures.

Why this paper matters

Overprojection is a common finding at consultation, and reducing it requires disassembling the tip, which risks losing support entirely. A large series with meaningful follow up gives usable rates for a technically demanding maneuver. It reports no measurement of how much projection was actually reduced or whether it held.

Terms

Tip projection: how far the nasal tip stands out from the plane of the face.
Deprojection: reducing how far the tip stands out.
Medial crura: the inner arms of the tip cartilages, running down toward the nostril base.
Lateral crural steal: borrowing length from the outer arm of the tip cartilage to reshape the tip.
Columellar strut: a cartilage post placed between the nostrils to support the tip.
Iatrogenic: caused by previous medical or surgical treatment.

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

From the abstract

“Rhinoplasty is one of the most commonly performed facial operations in the United States, and many major and minor nasal tip support structures affect tip projection. Overprojection may result from anatomical factors or occur iatrogenically during primary rhinoplasty. Achieving reliable, reproducible, and stable…”

Excerpt; the full abstract is on PubMed.