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Facial Plast Surg
DOI: 10.1055/a-2764-3583
Original Article

Tip Tensioning in Rhinoplasty

Authors

  • Joseph S. Schertzer

    1   Department of Otolaryngology–Head and Neck Surgery, University of South Florida, Tampa, Florida, United States

  • Edward H. Farrior

    1   Department of Otolaryngology–Head and Neck Surgery, University of South Florida, Tampa, Florida, United States
    2   Farrior Facial Plastic Surgery, Tampa, Florida, United States

  • Julia Toman

    1   Department of Otolaryngology–Head and Neck Surgery, University of South Florida, Tampa, Florida, United States
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Abstract

Aims and Background

This article aims to provide a comprehensive overview of nasal tip support, tensioning mechanics, and suture-based techniques that refine projection, rotation, and stability in rhinoplasty. Modern approaches emphasize predictable, structurally sound methods that balance form and function while accommodating individual anatomic variability. Understanding tension vectors and ligamentous relationships is essential for optimizing both aesthetics and long-term outcomes.

Historical Aspects

The evolution of nasal tip surgery reflects a shift from primarily reductive maneuvers to graft- and suture-based strategies that reinforce and shape the tip framework. Early innovators recognized the limitations of aggressive cartilage excision, leading to the development of both structural cartilage grafts and suture-based techniques to provide tip stability.

Anatomy

Tip anatomy is governed by the relationship between the lower lateral cartilages (LLCs), medial crural base, the caudal septum, and the soft-tissue envelope. Cartilage grafts bolster weak or asymmetric native structures, reinforcing the medial crural pillar or lateral crural support, while sutures fine-tune shape, redistribute tension, and harmonize graft-induced forces. Optimal outcomes depend on understanding how grafts and sutures interact biomechanically within the intrinsic support system.

Conclusions and Clinical Relevance

Integrating cartilage grafting with targeted suture techniques enables surgeons to control projection, rotation, and definition with greater precision. A combined structural and tension-modulating strategy enhances long-term stability, counteracts postoperative contracture, and provides durable, natural tip aesthetics across primary and secondary rhinoplasty.

Keywords

nasal tip - tip tensioning - alar–columellar relationship - secondary rhinoplasty


Publication History

Received: 25 November 2025

Accepted: 03 December 2025

Accepted Manuscript online:
05 December 2025

Article published online:
23 December 2025

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