Diagnosis and Surgical Management of the Caudal Excess Nasal Deformity

Modified Endonasal Tongue-in-Groove Technique

“…The TIG technique can be safely and reliably employed in endonasal rhinoplasty to improve TR and TP, correct excessive columellar show, and improve nasal tip support. 5,9 First introduced by Rethi 4 in 1934, TIG technique fell out of favor for quite some time until it was repopularized in the late 1980s, which seemingly correlated with popularization of open rhinoplasty. Since then it has been widely used primarily in open rhinoplasty approach by a variety of rhinoplasty surgeons who enjoyed the reliability of the changes in nasal tip that this technique provided.…”

Lateral Crural Tensioning for Refinement of the Wide and Underprojected Nasal Tip

“…12). 45,46 Because the combined TIG/LCS/SEG technique works to reposition and reconfigure the entire length of the LLC arch, tip refinement and nasal base profile aesthetics are both optimized, and unwanted increases in tip projection are avoided without negating the traditional benefits of LCS. Although the TIG setback is indispensable for reducing tip projection and/or enhancing nasal base profile aesthetics, it should be used judiciously when Lateral Crural Tensioning for Tip Refinement the nasolabial angle is normal to prevent hyperacuity of the columellar-labial junction.…”

Common Technical Causes of the Failed Rhinoplasty

“…Failure to recognize and treat excessive elongation of the caudal septum and nasal spine-known as the caudal excess nasal deformity-will invariably lead to a disappointing cosmetic outcome. 17 Although severe cases of the caudal excess deformity may require trimming of the overprojected caudal septum and/or nasal spine, most cases can be managed effectively with a tongue-in-groove setback of the medial crura to create a more attractive nasal base profile 17,18 (►Fig. 8).…”