Abstract
Aims and Backgrounds
This article describes the senior author's (M.S.) approach to nasal tip management
in primary rhinoplasty, integrating preservation concepts with selective structural
reinforcement to enhance long-term stability and refined definition.
Historical Aspects
Over 15 years, the technique transitioned from routine columellar strut grafting,
effective early but prone to late ptosis, to a septal-based philosophy centered on
the Teostrut and the septal extension graft (SEG), providing more predictable projection
control.
Anatomy
Clinical decision-making relies on assessment of skin thickness, lower lateral cartilage
strength, and inherent tip support, which together determine the degree of preservation
or reinforcement required.
Techniques
The operative approach combines preservation of native support when feasible, controlled
strengthening through Teostrut or SEG when indicated, conservative cephalic adjustments,
and precise dome–suture modulation. This sequence balances structural stability with
aesthetic subtlety while respecting tissue dynamics.
Current and Future Development
Refinements continue to evolve through improved mapping of cartilage responsiveness,
integration of regenerative strategies, and advancements in suture-based modulation.
Conclusions and Clinical Relevance
This experience-based approach offers reproducible, stable, and naturally refined
results in primary rhinoplasty, emphasizing durable tip support and patient-specific
aesthetic goals.
Keywords
preservation rhinoplasty - alar preservation - lower lateral cartilage - structure
rhinoplasty
