Dissatisfaction with Nasal Tip Shape: Secondary Tip Maneuvers

Abstract

Dissatisfaction with the appearance of the nasal tip is a common compliant in patients seeking revision surgery after rhinoplasty. Revision rhinoplasty is more technically difficult and unpredictable given the frequent presence of scar contracture, impaired skin envelope quality, and missing alar cartilage. This article describes some of the more common causes for tip revision surgery and techniques to address these abnormalities.

Keywords

rhinoplasty - nasal tip - revision surgery - complication

• References

• 1 Lee M, Zwiebel S, Guyuron B. Frequency of the preoperative flaws and commonly required maneuvers to correct them: a guide to reducing the revision rhinoplasty rate. Plast Reconstr Surg 2013; 132 (04) 769-776
• 2 Yu K, Kim A, Pearlman SJ. Functional and aesthetic concerns of patients seeking revision rhinoplasty. Arch Facial Plast Surg 2010; 12 (05) 291-297
• 3 Chauhan N, Alexander AJ, Sepehr A, Adamson PA. Patient complaints with primary versus revision rhinoplasty: analysis and practice implications. Aesthet Surg J 2011; 31 (07) 775-780
• 4 East C, Kwame I, Hannan SA. Revision rhinoplasty: what can we learn from error patterns? An analysis of revision surgery. Facial Plast Surg 2016; 32 (04) 409-415
• 5 Adamson PA, Warner J, Becker D, Romo III TJ, Toriumi DM. Revision rhinoplasty: panel discussion, controversies, and techniques. Facial Plast Surg Clin North Am 2014; 22 (01) 57-96
• 6 Joseph AW, Ishii L, Joseph SS. , et al. Prevalence of body dysmorphic disorder and surgeon diagnostic accuracy in facial plastic and oculoplastic surgery clinics. JAMA Facial Plast Surg 2017; 19 (04) 269-274
• 7 Constantian MB, Clardy RB. The relative importance of septal and nasal valvular surgery in correcting airway obstruction in primary and secondary rhinoplasty. Plast Reconstr Surg 1996; 98 (01) 38-54 , discussion 55–58
• 8 Gunter JP, Friedman RM. Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg 1997; 99 (04) 943-952 , discussion 953–955
• 9 Toriumi DM. Discussion: frequency of the preoperative flaws and commonly required maneuvers to correct them: a guide to reducing the revision rhinoplasty rate. Plast Reconstr Surg 2013; 132 (04) 777-779
• 10 Rohrich RJ, Raniere Jr J, Ha RY. The alar contour graft: correction and prevention of alar rim deformities in rhinoplasty. Plast Reconstr Surg 2002; 109 (07) 2495-2505 , discussion 2506–2508
• 11 Rohrich RJ, Hoxworth RE, Kurkjian TJ. The role of the columellar strut in rhinoplasty: indications and rationale. Plast Reconstr Surg 2012; 129 (01) 118e-125e
• 12 Rohrich RJ, Kurkjian TJ, Hoxworth RE, Stephan PJ, Mojallal A. The effect of the columellar strut graft on nasal tip position in primary rhinoplasty. Plast Reconstr Surg 2012; 130 (04) 926-932
• 13 Lee JW, Baker SR. Correction of caudal septal deviation and deformity using nasal septal bone grafts. JAMA Facial Plast Surg 2013; 15 (02) 96-100
• 14 Caughlin BP, Been MJ, Rashan AR, Toriumi DM. The effect of polydioxanone absorbable plates in septorhinoplasty for stabilizing caudal septal extension grafts. JAMA Facial Plast Surg 2015; 17 (02) 120-125
• 15 Kridel RW, Scott BA, Foda HM. The tongue-in-groove technique in septorhinoplasty. A 10-year experience. Arch Facial Plast Surg 1999; 1 (04) 246-256 , discussion 257–258
• 16 Datema FR, Lohuis PJ. The tongue-in-groove technique in primary and revision rhinoplasty. Facial Plast Surg 2016; 32 (04) 416-423
• 17 Stephan S, Wang TD. Asymmetric nasal tip. Facial Plast Surg 2012; 28 (02) 177-186
• 18 Gillman GS, Simons RL, Lee DJ. Nasal tip bossae in rhinoplasty. Etiology, predisposing factors, and management techniques. Arch Facial Plast Surg 1999; 1 (02) 83-89
• 19 Toriumi DM, Asher SA. Lateral crural repositioning for treatment of cephalic malposition. Facial Plast Surg Clin North Am 2015; 23 (01) 55-71
• 20 Toriumi DM. New concepts in nasal tip contouring. Arch Facial Plast Surg 2006; 8 (03) 156-185
• 21 Troell RJ, Powell NB, Riley RW, Li KK. Evaluation of a new procedure for nasal alar rim and valve collapse: nasal alar rim reconstruction. Otolaryngol Head Neck Surg 2000; 122 (02) 204-211
• 22 Guyuron B, Bigdeli Y, Sajjadian A. Dynamics of the alar rim graft. Plast Reconstr Surg 2015; 135 (04) 981-986
• 23 Unger JG, Roostaeian J, Small KH. , et al. Alar contour grafts in rhinoplasty: a safe and reproducible way to refine alar contour aesthetics. Plast Reconstr Surg 2016; 137 (01) 52-61
• 24 Kridel RW, Soliemanzadeh P. Tip grafts in revision rhinoplasty. Facial Plast Surg Clin North Am 2006; 14 (04) 331-341 , vi vi.
• 25 Daniel RK. Tip refinement grafts: the designer tip. Aesthet Surg J 2009; 29 (06) 528-537
• 26 Peck GC. The onlay graft for nasal tip projection. Plast Reconstr Surg 1983; 71 (01) 27-39
• 27 Sheen JH. Tip graft: a 20-year retrospective. Plast Reconstr Surg 1993; 91 (01) 48-63
• 28 McCollough EG, English JL. A new twist in nasal tip surgery. An alternative to the Goldman tip for the wide or bulbous lobule. Arch Otolaryngol 1985; 111 (08) 524-529
• 29 Tardy Jr ME. E C. Transdomal suture refinement of the nasal tip. Facial Plast Surg 1987; 4 (04) 317-326
• 30 Daniel RK. Rhinoplasty: creating an aesthetic tip. A preliminary report. Plast Reconstr Surg 1987; 80 (06) 775-783
• 31 Daniel RK. Rhinoplasty: a simplified, three-stitch, open tip suture technique. Part I: primary rhinoplasty. Plast Reconstr Surg 1999; 103 (05) 1491-1502
• 32 Daniel RK. Rhinoplasty: a simplified, three-stitch, open tip suture technique. Part II: secondary rhinoplasty. Plast Reconstr Surg 1999; 103 (05) 1503-1512
• 33 Gruber RP, Nahai F, Bogdan MA, Friedman GD. Changing the convexity and concavity of nasal cartilages and cartilage grafts with horizontal mattress sutures: part I. Experimental results. Plast Reconstr Surg 2005; 115 (02) 589-594
• 34 Gruber RP, Nahai F, Bogdan MA, Friedman GD. Changing the convexity and concavity of nasal cartilages and cartilage grafts with horizontal mattress sutures: part II. Clinical results. Plast Reconstr Surg 2005; 115 (02) 595-606 , discussion 607–608
• 35 Gruber RP, Peled A, Talley J. Mattress sutures to remove unwanted convexity and concavity of the nasal tip: 12-year follow-up. Aesthet Surg J 2015; 35 (01) 20-27
• 36 Farrior EH, Ballert JA. Nuances of the nasal tip: rhinoplasty of the thin-skinned nose. Facial Plast Surg 2012; 28 (02) 171-176
• 37 Constantian MB. What motivates secondary rhinoplasty? A study of 150 consecutive patients. Plast Reconstr Surg 2012; 130 (03) 667-678