Facial Plast Surg 2012; 28(02): 177-186
DOI: 10.1055/s-0032-1309297
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Asymmetric Nasal Tip

Scott Stephan
1   Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
,
Tom D. Wang
2   Division of Facial Plastic and Reconstructive Surgery, Department Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
› Author Affiliations
Further Information

Publication History

Publication Date:
06 May 2012 (online)

Abstract

Asymmetry of the nasal tip is a common finding in the setting of primary and revision rhinoplasty. Careful preoperative analysis is imperative to identify the anatomic etiology of the asymmetry to develop an appropriate surgical plan to correct it. This article describes the anatomic structures that affect the overall appearance of the nasal tip, explains how intrinsic asymmetries can alter nasal tip appearance, and offers a menu of surgical techniques that can be used to correct these asymmetries.

 
  • References

  • 1 Constantian MB. The two essential elements for planning tip surgery in primary and secondary rhinoplasty: observations based on review of 100 consecutive patients. Plast Reconstr Surg 2004; 114: 1571-1581 ; discussion 1582–1585
  • 2 Adamson PA, McGraw-Wall BL, Morrow TA, Constantinides MS. Vertical dome division in open rhinoplasty. An update on indications, techniques, and results. Arch Otolaryngol Head Neck Surg 1994; 120: 373-380
  • 3 Gunter JP, Rohrich RJ. Management of the deviated nose. The importance of septal reconstruction. Clin Plast Surg 1988; 15: 43-55
  • 4 Rohrich RJ, Adams Jr WP. The boxy nasal tip: classification and management based on alar cartilage suturing techniques. Plast Reconstr Surg 2001; 107: 1849-1863 ; discussion 1864–1868
  • 5 Kamer FM, Churukian MM, Hansen L. The nasal bossa: a complication of rhinoplasty. Laryngoscope 1986; 96: 303-307
  • 6 Rohrich RJ, Griffin JR. Correction of intrinsic nasal tip asymmetries in primary rhinoplasty. Plast Reconstr Surg 2003; 112: 1699-1712 ; discussion 713–715
  • 7 Hafezi F, Naghibzadeh B, Nouhi AH. Applied anatomy of the nasal lower lateral cartilage: a new finding. Aesthetic Plast Surg 2010; 34: 244-248
  • 8 Stoksted P, Gutierrez C. Obtaining a gentle contour to the columella by modifying the maxillary spine. Plast Reconstr Surg 1981; 68: 689-695
  • 9 Yu K, Kim A, Pearlman SJ. Functional and aesthetic concerns of patients seeking revision rhinoplasty. Arch Facial Plast Surg 2010; 12: 291-297
  • 10 Kridel RW, Yoon PJ, Koch RJ. Prevention and correction of nasal tip bossae in rhinoplasty. Arch Facial Plast Surg 2003; 5: 416-422
  • 11 Simons R, Gallo J. Rhinoplasty complications. Facial Plast Surg Clin 1994; 2: 521-529
  • 12 Simons RL. Vertical dome division in rhinoplasty. Otolaryngol Clin North Am 1987; 20: 785-796
  • 13 Goodwin Jr WJ, Schmidt JF. Iatrogenic nasal tip bossae. Etiology, prevention, and treatment. Arch Otolaryngol Head Neck Surg 1987; 113: 737-739
  • 14 Tardy Jr ME, Cheng EY, Jernstrom V. Misadventures in nasal tip surgery. Analysis and repair. Otolaryngol Clin North Am 1987; 20: 797-823
  • 15 Gillman GS, Simons RL, Lee DJ. Nasal tip bossae in rhinoplasty. Etiology, predisposing factors, and management techniques. Arch Facial Plast Surg 1999; 1: 83-89
  • 16 Constantian MB. An algorithm for correcting the asymmetrical nose. Plast Reconstr Surg 1989; 83: 801-811
  • 17 Byrd HS, Salomon J, Flood J. Correction of the crooked nose. Plast Reconstr Surg 1998; 102: 2148-2157
  • 18 Kridel RW, Konior RJ, Shumrick KA, Wright WK. Advances in nasal tip surgery. The lateral crural steal. Arch Otolaryngol Head Neck Surg 1989; 115: 1206-1212
  • 19 Kridel RW, Konior RJ. Dome truncation for management of the overprojected nasal tip. Ann Plast Surg 1990; 24: 385-396
  • 20 Kamer FM, McQuown SA. Revision rhinoplasty. Analysis and treatment. Arch Otolaryngol Head Neck Surg 1988; 114: 257-266
  • 21 Parkes MH, Kanodia R, Kern EB. The universal tip: a systematic approach to aesthetic problems of the lower lateral cartilages. Plast Reconstr Surg 1988; 81: 878-890
  • 22 Funk E, Chauhan N, Adamson PA. Refining vertical lobule division in open septorhinoplasty. Arch Facial Plast Surg 2009; 11: 120-125
  • 23 Neu BR. Suture correction of nasal tip cartilage concavities. Plast Reconstr Surg 1996; 98: 971-979
  • 24 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: 524-529
  • 25 Tardy Jr ME, Patt BS, Walter MA. Transdomal suture refinement of the nasal tip: long-term outcomes. Facial Plast Surg 1993; 9: 275-284
  • 26 Guyuron B, Behmand RA. Nasal tip sutures part II: the interplays. Plast Reconstr Surg 2003; 112: 1130-1145 ; discussion 1146–1149
  • 27 Baker SR. Suture contouring of the nasal tip. Arch Facial Plast Surg 2000; 2: 34-42