Deprojecting the Nasal Profile

Transfixion incision as an initial technique in nasal tip deprojection

“…These techniques include the release of fibrous attachments, decreasing the volume of overdeveloped anatomic components, and repositioning the medial or lateral crura (9). Other methods that give the illusion of a reduced nasal tip by de-emphasizing nasal projection through the augmentation of adjacent structures have also been described (9).…”

“…Further studies by Petroff et al (10) confirmed that this was important in the postsurgical nose. A complete transfixion incision interrupts both mucosal surfaces and medial crural attachments, allowing the tip to settle closer to the face (9). This technique has been recognized as a useful method to deproject the nasal tip, either alone or with other procedures to correct mild to moderate degrees of overprojection.…”

“…The anatomical components that may be overdeveloped include the alar cartilage, septal cartilage and nasal spine (9). However, a deficiency of adjacent structures involving the nasofrontal angle, any saddlenose deformity, mandibular retrusion or anterior displacement of the maxilla may also contribute to an overprojectedappearing nasal tip.…”

“…Other less destructive techniques include releasing fibrous attachments, using either the delivery approach, or a full or complete transfixion incision (9). A full transfixion incision disrupts the attachment of the medial crura to the caudal septum, which weakens nasal tip support, resulting in deprojection of the tip.…”

Decreasing Nasal Tip Projection in Rhinoplasty

“…15,[28][29][30] The alar cartilages themselves are primarily responsible for tip projection, as they not only protrude from the underlying bony framework but also abut the upper lateral cartilages and nasal septum.…”