Suture contouring of the nasal tip

Scoring, morselizing, and resecting the alar cartilages in an attempt to modify the position and shape of the nasal tip may lead to postoperative distortions of the lobule. Contour grafts have the disadvantage of asymmetries, visible irregularities, and absorption. For these reasons, surgeons have adopted suture techniques as the primary method of recontouring the alar cartilages. My philosophy in dealing with mild to moderate tip deformities consists of the following principles: (1) limited or no resection of cartilages; (2) no scoring or morselization of alar cartilages, which produces irreversible change and unpredictable results; (3) use of support grafts in the form of columellar struts and lateral crural battens to supplement structure and correct intrinsic alar cartilage weaknesses; (4) reliance primarily on the use of sutures to recontour and position the tip; and (5) limited use of contour grafts for situations that cannot be corrected with sutures and support grafts. Arch Facial Plast Surg. 2000;2:34-42     

Asymmetric nasal tip

Asymmetry of the nasal tip is a common finding in the setting of primary and revision rhinoplasty. Careful preoperative analysis is imperative to identify the anatomic etiology of the asymmetry to develop an appropriate surgical plan to correct it. This article describes the anatomic structures that affect the overall appearance of the nasal tip, explains how intrinsic asymmetries can alter nasal tip appearance, and offers a menu of surgical techniques that can be used to correct these asymmetries.     

The crooked nasal tip

Successful treatment of the crooked nasal tip includes proper analysis and assessment, employment of the proper techniques, reaching ideal tip dynamics, and close follow-up. Both the caudal septum and the nasal tip cartilages must be addressed. When executed properly, satisfaction should be high for both the patient and the surgeon.     

The droopy nasal tip

Nasal tip drooping following primary rhinoplasty often results secondary to disruption of nasal tip support. Predictable correction of this problem requires restoration of support within the destabilized nasal tip. This article highlights the use of structural augmentation and precise suture stabilization methods via the open rhinoplasty approach for repairing the postrhinoplasty droopy nasal tip.     

The prominent nasal tip

The authors associate the projection of the nasal tip to hypertrophy of the alar cartilages and, more specifically, of their medial branches. The heavy, blobby, or bulbous nose is caused by an increase of the columellar-alar angle of the alar cartilages, and bears no relationship to the cephalometric nasal index. Moreover, the bulbous nose usually has excess fatty tissue present in the tip of the nose. The projecting tip may be corrected by excising a rectangular or quadrangular segment from the medial branches of the alar cartilages, or by resecting the cupula of the alar cartilages, including a small or large segment of its medial branch, in order to obtain the desired effect, namely, to lower the tip and decrease the columellar-alar angle. The nasal index remains unchanged. If in addition, the tip of the nose is bulbous, the fatty tissue should be removed at the same time.     

鼻背皮瓣修复鼻尖缺损的探讨

目的 探讨应用鼻背皮瓣修复鼻尖区组织缺损的方法和效果.方法 根据患者鼻缺损的部位及范围设计鼻背皮瓣,旋转前徙覆盖创面再造鼻尖,修复过程中注意保护各美学单元的完整性,利用天然皱褶掩盖瘢痕.结果 本组4例患者鼻背皮瓣均完全成活,术后随访1～4年,鼻外形良好,效果满意.结论 鼻背皮瓣对于鼻尖1.5～2.5cm的缺损能够提供色泽、质地匹配的修复.     

鼻中隔软骨在鼻尖整形中的应用

目的：探讨在鼻尖圆钝或低平整形中应用鼻中隔软骨的手术方法及效果。方法：本组35例患者均采用“开放式”切口。根据鼻尖情况,修剪过多软组织,切取鼻中隔软骨,构建鼻尖及鼻小柱软骨支架,以重塑鼻尖形态。结果：自2005年以来,用上述方法整复35例患者,经6个月～2年随访,除6例单纯行鼻尖圆钝整形的患者感鼻尖较低外,其余29例均感满意,效果稳定。结论：在鼻尖圆钝或低平整形中应用鼻中隔软骨可取得良好效果。     

Grafting the projecting nasal tip

Cartilage grafting in some projecting nasal tips can enhance the result obtainable by modifying the alar cartilages alone: where there is a sizeable discrepancy between skin sleeve and skeletal volumes, or where a small tip requires a change in configuration. These principles are defined and illustrated in primary rhinoplasty.     

Reconstruction of nasal tip and columella

Reconstruction of nasal tip and columella defects is demanding area with a range of reconstructive options, varying in complexity depending on requirements from simple skin grafting to multiple stage reconstruction with regional flaps. A framework is suggested to aid the reader in choice of reconstruction by classifying the defect based on size and the requirements of one to three layer (full thickness) reconstruction.     

Functional support of the nasal tip

Surgery of the nasal tip is among the most challenging aspects of rhinoplasty. Abnormalities of the nasal tip, whether primary or iatrogenic, have both functional and aesthetic consequences. This review focuses on the functional support of the nasal tip, surgical techniques commonly used to improve nasal tip support and function, and the effects of these techniques on the appearance of the nose.     

Metastatic tumours of the nasal tip

Two cases of metastatic tumour at the nasal tip are described. Both originated from a primary tumour of the bronchus. In each case the lesion was the first sign of an otherwise silent neoplasm.     

An approach to nasal tip remodeling

The luxation (cartilage delivery) technique may be used to achieve a predictable, individualized result in nasal tip rhinoplasty. The author describes how this technique, using a bipedicle flap with an intercartilaginous and rim incision, allows superior visualization of the domal region without structural disruption of the cartilaginous arch. (Aesthetic Surg J 2001;21:345-348.)     

鼻尖肥大的整形修复

目的　探讨治疗鼻尖肥大的手术方法 ,以获得美观鼻外形。方法　本组 2 8例患者 ,均采用“飞鸟形”切口 ,根据鼻尖形态 ,修剪鼻尖部过多的软组织 ;显露鼻翼软骨外侧脚和穹窿后 ,剪除外侧脚至穹窿处侧鼻软骨侧部分软骨 ,保留鼻翼缘处 0 .2cm宽鼻翼软骨外侧脚 ,缝合穹窿以重塑鼻尖外形。矫正鼻部其他畸形 :10例鼻尖低平者 ,行硅胶假体隆鼻 ;9例鼻翼肥厚者 ,修薄鼻翼缘 ;3例鼻翼基底过宽者 ,经口内入路缝合缩窄鼻翼 ;1例鼻底过宽者 ,凿开上颌骨鼻突 ,挤压缩窄塑形。结果　自 1995年以来 ,用上述方法整复 2 8例患者 ,经 3个月至 2年随访 ,除 3例鼻尖肥大矫正不足外 ,其余 2 5例效果稳定 ,无继发畸形发生。结论　鼻尖肥大需综合整复 ,方能获得良好的效果。