Date: March 2003
Conference: 21st Meeting of the Korean Academy of Aesthetic Plastic Surgery (Shilla Hotel) – Panelist
Title: Nasal Tip Plasty

Background

The nasal tip is crucial to overall facial aesthetics and nasal harmony. Its shape depends on proper contour, proportions, and angles between the nasal dorsum and columella. Since the tip is primarily cartilaginous, conventional rhinoplasty techniques can fall short in refining it. Therefore, the author categorizes nasal tip issues into four types, each requiring a specific surgical approach.

Methods & Materials

Type 1: Inadequate Tip Projection Due to Weak Cartilage

• Characteristics: Poor tip projection resulting from underdeveloped lower lateral cartilages.
• Technique:
  1. Columellar Strut Graft to provide core tip support.
  2. Additional Cartilage Grafting (onlay or shield) depending on the direction and degree of tip height needed.
     • Single or Multiple Grafts may be used based on the desired elevation.
  3. Preferred Material: Septal cartilage.
• Goal: Elevate and extend the tip for improved definition.

Type 2: Concomitant Paranasal or Alar Base Procedures

• Characteristics:
  • Underdeveloped paranasal region (the “foundation” under the nose).
  • Wide alar base or lower nose area out of proportion with tip height.
  • Excessive nasal tip muscle activity.
• Technique:
  • Paranasal Augmentation to add support at the nasal base.
  • Nasal Alar Resection / Base Narrowing to address flared or wide nostrils.
  • Myectomy (Muscle Resection) for overactive tip musculature.
• Goal: Correct both tip projection (often via septal support) and the surrounding bony/soft-tissue deficiencies for a harmonious outcome.

Type 3: Nasal Tip Asymmetry from Septal Deviation

• Characteristics:
  • Tip asymmetry resulting from a deviated lower septum.
  • When the lower septum remains misaligned, tip refinement alone won’t fix the underlying asymmetry.
• Technique:
  1. Swing Door Septoplasty to realign the deviated caudal septum.
  2. If more stability is needed, place a Batten Graft to reinforce the septum and maintain symmetry.
• Goal: Correct septal deviation to ensure the tip is positioned symmetrically.

Type 4: Overall Deficient Nasal Framework

• Characteristics:
  • Underdeveloped cartilages (lower lateral and septum) and thin, weak nasal skin.
  • High risk of complications if relying on synthetic implants.
• Technique:
  1. Autologous Tissue Reconstruction to safely and effectively build up tip length and strength.
  2. Preferred Material: Rib cartilage (costal cartilage).
     • Reinforce the tip’s structural elements.
     • Augment the dorsum if needed using the same rib graft.
• Goal: Achieve significant enhancement in tip projection and overall shape using robust, biocompatible tissue to minimize complications.

Conclusion

Nasal tip refinement should be tailored to the patient’s underlying structural deficiencies. By identifying the root causes—whether insufficient cartilage, paranasal underdevelopment, septal deviation, or globally weak nasal support—surgeons can employ specific techniques (and materials like septal or rib cartilage) to achieve a stable, aesthetically pleasing result.