Functional Support of the Nasal Tip

Friedman, Oren; Koch, Cody A.; Smith, William Russell

doi:10.1055/s-0032-1309303

Cited by 21 publications

(10 citation statements)

References 17 publications

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“…An inappropriate resection of cartilage and the use of grafts and sutures can lead to nasal tip deformities, including ptosis, alar collapse, retraction, and pinching. 17 Therefore, it becomes very important for a surgeon to have an idea of the normal values of NTP for that particular region. The surgeon can thus focus on these normal values while deciding on patient suitability for rhinoplasty (patients with over-and under-projected noses will thus be obvious candidates for rhinoplasty).…”

Section: Discussionmentioning

confidence: 99%

Study on Nasal Tip Projection of South Indian Population to derive Reference Values for Corrective Nasal Surgeries

Siddapur¹,

Siddapur²

2017

An International Journal Clinical Rhinology

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Aim: The present study was taken up with an objective to derive reference values in relation to nasal tip projection (NTP) of Tamil Nadu population. Materials and methods:The present study was conducted with the approval of the Institutional Ethics Committee. A total of 118 medical students from Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India, participated in the study. Consenting students were included and individuals with noticeable facial disfigurement and with history of previous facial surgery were excluded. Goode method was used to analyze NTP. Results:The present study reports NTP of 0.65 (0.66 in males and 0.64 in females) with standard deviation (SD) of 0.06 in South Indian population of Tamil Nadu region.Conclusion: Nasal tip projection can be considered as a ratio that can be used while planning corrective nasal surgeries, and can be used in a simple and effective manner than other parameters like nasal angles and indices, and nasal morphology.Clinical significance: The present study results will help surgeons avoid complications by anticipating the healing forces and take into account support mechanisms of the nasal tip when planning an optimal approach for esthetic nasal surgeries on patients, especially of our geographical area, and of the ethnic group that has been studied on. Also, surgeons from other parts of the world can use the present study results as reference while planning similar surgeries.

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Section: Discussionmentioning

confidence: 99%

Study on Nasal Tip Projection of South Indian Population to derive Reference Values for Corrective Nasal Surgeries

Siddapur¹,

Siddapur²

2017

An International Journal Clinical Rhinology

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“…According to the tripod theory, [15][16][17] the lateral crura serve as major legs in the nasal tip supporting system, but obstruction of the external valve and/or an alar collapse will not occur unless the remaining width of the lateral crus is less than 4 to 6 mm. 1,16,18 Meanwhile, the pronasale area in the tripod structure is improved as a result of the cartilaginous flap crossover fixation, thus functionally intensifying the tip and alar framework. Several types of maneuvers designed to reuse the cephalic portion of the LLC through open approach have been reported [18][19][20] to yield satisfactory outcomes of improvement in tip definition and projection.…”

Section: Discussionmentioning

confidence: 99%

Broad Tip Modification in Asian Patients Undergoing Rhinoplasty Using the Low-Lateral Cartilage Cruciate Overlap Technique

Yin

Liu

Fan

et al. 2015

JAMA Facial Plast Surg

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IMPORTANCE Asian patients undergoing cosmetic rhinoplasty often want surgeons to concentrate on the broad nasal tip. Modifying the cartilage framework is considered to be the fundamental strategy; during the modification procedures, the cephalic portion of the lower lateral cartilage is often excised and discarded. However, given the supporting function and volumetric filling properties of autologous cartilage, the cephalic cartilage should and can be salvaged by using our cruciate overlap technique.OBJECTIVES To introduce a novel technique in modification of broad nasal tip in Asian patients undergoing rhinoplasty and assess its efficacy and safety. DESIGN, SETTING, AND PARTICIPANTS Dissection of 5 fresh cadaver head specimens was performed and the plausibility and reliability of the new procedure were determined at Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. In addition, the cruciate overlap technique was performed in 43 Chinese patients between January 1, 2011, and December 31, 2013, and the surgical results were assessed subjectively and objectively during the follow-up period, ranging from 12 to 36 months, with the final follow-up November 30, 2014. Anthropometric measurements of patients' noses preoperatively and postoperatively were taken and the patients' complications were reviewed.MAIN OUTCOMES AND MEASURES Cadaveric evaluation, subjective and objective assessments of the surgical results (rated on a scale of 1 to 4, with 4 indicating much improvement from the preoperative level), nasal measurements of the patients, and evaluation of the complications. RESULTSThe mean size of the cartilaginous flap in the cruciate overlap technique was 12.0 mm long and 3.0 mm wide, allowing for 180°rotation and graft coverage, with the nasal cartilage framework protected from collapse. Mean (SD) scores for the subjective and objective judgment of the outcomes were 3.3 (0.4) and 3.5 (0.3), respectively. Moreover, nasal measurements demonstrated significant postoperative improvement by increasing the mean nasal tip protrusion (from 14.3 [1.5] to 16.7 [2.0] mm) and reducing the mean tip width (from 22.7 [1.7] to 18.2 [1.6] mm) and tip angle (from 101.0°[6.3°] to 87.7°[6.7°]) (all P < .001). Acceptable ranges of edema, ecchymosis, and pain were observed in the early postoperative period and resolved within a short period. No aesthetic or functional adverse effects were reported during the follow-up period. CONCLUSIONS AND RELEVANCEThe cruciate overlap technique is an efficacious and reliable alternative for modification of broad nasal tips in Asian patients undergoing rhinoplasty.LEVEL OF EVIDENCE 4.

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“…4) may help to prevent ptosis of the nasal tip and represent some of the more commonly employed techniques for tip revisions. 36 A shield graft is a piece of cartilage placed along the infratip lobule portion of the nasal tip that helps to define and project the nose. It may also be used to provide structural support to alar replacement grafts or to existing weak lateral crura in a manner similar to a gusset plate on a bridge construct.…”

Section: Tip Revisionmentioning

confidence: 99%

Functional Compromise in the Middle Vault in the Management of Revision Rhinoplasty

Wang

Friedman

2018

Facial plast Surg

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As rhinoplasty procedures become more common, the need for revision surgeries increases as well. Unlike primary rhinoplasties, revision rhinoplasties can be more challenging because of anatomic differences from initial surgery, a lack of available cartilage, tissue remodeling responses, and other complications. As such, surgeons should be prepared to address revision rhinoplasty patients differently from primary rhinoplasty patients. Here, the authors describe a generalizable approach to revision functional rhinoplasty patients and detail some of the surgical techniques that can be employed to achieve optimal outcomes, with particular attention paid to procedures that can be used in the middle vault.

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Functional Support of the Nasal Tip

Cited by 21 publications

References 17 publications

Study on Nasal Tip Projection of South Indian Population to derive Reference Values for Corrective Nasal Surgeries

Study on Nasal Tip Projection of South Indian Population to derive Reference Values for Corrective Nasal Surgeries

Broad Tip Modification in Asian Patients Undergoing Rhinoplasty Using the Low-Lateral Cartilage Cruciate Overlap Technique

Functional Compromise in the Middle Vault in the Management of Revision Rhinoplasty

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