Management of the Droopy Tip: A Comparison of Three Alar Cartilage–Modifying Techniques

Abstract

The droopy tip is a common nasal deformity in which the tip is inferiorly rotated. Five hundred consecutive rhinoplasty cases were studied to assess the incidence and causes of the droopy tip deformity and to evaluate the role of three alar cartilage-modifying techniques--lateral crural steal, lateral crural overlay, and tongue in groove--in correcting such a deformity. The external rhinoplasty approach was used in all cases. Only one of the three alar cartilage-modifying techniques was used in each case, and the degree of tip rotation and projection was measured both preoperatively and postoperatively. The incidence of droopy tip was 72 percent, and the use of an alar cartilage-modifying technique was required in 85 percent of these cases to achieve the desired degree of rotation. The main causes of droopy tip included inferiorly oriented alar cartilages (85 percent), overdeveloped scrolls of upper lateral cartilages (73 percent), high anterior septal angle (65 percent), and thick skin of the nasal lobule (56 percent). The lateral crural steal technique increased nasal tip rotation and projection, the lateral crural overlay technique increased tip rotation and decreased tip projection, and the tongue-in-groove technique increased tip rotation without significantly changing the amount of projection. The lateral crural overlay technique resulted in the highest degrees of rotation, followed by the lateral crural steal and finally the tongue-in-groove technique. According to these results, the lateral crural steal technique is best indicated in cases with droopy underprojected nasal tip, the lateral crural overlay technique in cases of droopy overprojected nasal tip, and the tongue-in-groove technique in cases where the droopy nasal tip is associated with an adequate amount of projection.

Lateral Crural Setback With Cephalic Turn-in Flap

“…Removal of the cephalic portion of LLC is a well-known method of narrowing and rotating the nasal tip cephalically. 3 Other techniques using aggressive resection of LLC could compromise tip support and the nasal valve, creating a potential for future alar collapse. 2,3 Alar collapse is the direct result of a weakness in the lateral portion of the LLC.…”

“…The second group has a normal alar cartilage that is inferiorly pushed by the effect of extrinsic factors, such as elongated upper lateral cartilages or excessive caudal anterior septum and heavy nasal skin. 2,3 Correction of the drooping nose varies according to the cause of the deformity. Typically it has been achieved through a variety of cartilage-modifying maneuvers based on incising or excising cartilaginous structures, generally LC of lower lateral cartilages (LLC).…”

“…Typically it has been achieved through a variety of cartilage-modifying maneuvers based on incising or excising cartilaginous structures, generally LC of lower lateral cartilages (LLC). [2][3][4][5][6] The LC of LLC is an essential aesthetic and functional structure of the nose. Aesthetically, it determines the shape, size, and position of the nasal tip.…”

Nasal tip surgery: nasal lengthening and augmentation in Asian rhinoplasty

“…In addition to its usage to correct excessive columellar show and the droopy tip, the TIG technique can be used to provide additional lateral stability to a septal extension/ www.jcosmetmed.org columellar strut graft [13][14][15][16][17][18][19][20][21].…”

External Rhinoplasty: Analysis of 50 Consecutive Cases.

“…[13][14][15][16][17][18][19] On the other hand, techniques that were used significantly more in secondary cases were those aiming at reconstruction and augmentation of the deficient nasal framework by various grafting tech-niques such as dorsal grafts, tip grafts, 20 spreader grafts, 21 premaxillary grafts, medial crural struts, and lateral crural struts.…”