eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Cosmetic Surgery

Rhinoplasty, Broad Nasal Tip: Multimedia

Author: J Charlie Finn, MD, Assistant Consulting Professor of Surgery, Department of Surgery, Duke University
Contributor Information and Disclosures

Updated: Jul 8, 2008

Multimedia

Preoperative and 6 months postoperative patient w...
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Media file 1: Preoperative and 6 months postoperative patient with thin skin, strong cartilages, and tip bifidity is pictured. Double-dome sutures, conservative cephalic resection, and tip grafting can be performed to narrow the nasal tip.
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Preoperative and 6 months postoperative patient w...

Preoperative and 6 months postoperative patient with thin skin, strong cartilages, and tip bifidity is pictured. Double-dome sutures, conservative cephalic resection, and tip grafting can be performed to narrow the nasal tip.

Cartilage shape and strength should be palpated a...
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Media file 2: Cartilage shape and strength should be palpated and anticipated preoperatively.
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Cartilage shape and strength should be palpated a...

Cartilage shape and strength should be palpated and anticipated preoperatively.

Conservative cephalic trim of lower lateral carti...
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Media file 3: Conservative cephalic trim of lower lateral cartilages alone can be effective in addressing a mildly bulbous tip. When performing domal suturing in a patient with strong lower lateral cartilages, conservative cephalic resection slightly weakens the cartilage, allowing it to bend. At least 8-10 mm of cartilage is preserved to retain strength.
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Conservative cephalic trim of lower lateral carti...

Conservative cephalic trim of lower lateral cartilages alone can be effective in addressing a mildly bulbous tip. When performing domal suturing in a patient with strong lower lateral cartilages, conservative cephalic resection slightly weakens the cartilage, allowing it to bend. At least 8-10 mm of cartilage is preserved to retain strength.

Mattress sutures are placed to move the domes sli...
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Media file 4: Mattress sutures are placed to move the domes slightly cephalad, providing slight upward rotation of the tip. Great care is used to place these sutures in a symmetrical fashion.
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Mattress sutures are placed to move the domes sli...

Mattress sutures are placed to move the domes slightly cephalad, providing slight upward rotation of the tip. Great care is used to place these sutures in a symmetrical fashion.

Sutures are carefully tightened to create the new...
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Media file 5: Sutures are carefully tightened to create the new dome. One suture can be left long on each knot so that they can be tied together. Alternatively, an individual interdomal suture may be placed.
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Sutures are carefully tightened to create the new...

Sutures are carefully tightened to create the new dome. One suture can be left long on each knot so that they can be tied together. Alternatively, an individual interdomal suture may be placed.

Sutures are joined to create a double-dome suture...
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Media file 6: Sutures are joined to create a double-dome suture. Care is taken to make sure the domes are at equal levels. If the suture is not perfect, it is removed and replaced.
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Sutures are joined to create a double-dome suture...

Sutures are joined to create a double-dome suture. Care is taken to make sure the domes are at equal levels. If the suture is not perfect, it is removed and replaced.

Dome division to narrow the nasal tip: Division a...
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Media file 7: Dome division to narrow the nasal tip: Division and suturing also may have secondary tip effects in tip projection and rotation.
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Dome division to narrow the nasal tip: Division a...

Dome division to narrow the nasal tip: Division and suturing also may have secondary tip effects in tip projection and rotation.

A tip graft may be used in certain situations.
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Media file 8: A tip graft may be used in certain situations.
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A tip graft may be used in certain situations.

A tip graft may be used in certain situations.

Tip grafts can be used to create the illusion of ...
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Media file 9: Tip grafts can be used to create the illusion of a narrowed tip. Placement in different areas can have different effects.
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Tip grafts can be used to create the illusion of ...

Tip grafts can be used to create the illusion of a narrowed tip. Placement in different areas can have different effects.

Postoperative result is superimposed over tip mod...
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Media file 10: Postoperative result is superimposed over tip modifications.
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Postoperative result is superimposed over tip mod...

Postoperative result is superimposed over tip modifications.

More on Rhinoplasty, Broad Nasal Tip

Overview: Rhinoplasty, Broad Nasal Tip
Treatment: Rhinoplasty, Broad Nasal Tip
Multimedia: Rhinoplasty, Broad Nasal Tip
References
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References

  1. Goldman IB. The importance of the medial crura in nasal tip reconstruction. Arch Otolaryngol. 1957;65:143.

  2. Simons RL. Management of the lower third of the nose: Vertical dome division. In: Rhinoplasty: A Practical Guide to Functional and Aesthetic Surgery of the Nose. Kugler Publications; 1998:314-9.

  3. Simons RL. Vertical dome division in rhinoplasty. Otolaryngol Clin North Am. Nov 1987;20(4):785-96. [Medline].

  4. Gunter JP, Friedman RM. Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg. Apr 1997;99(4):943-52; discussion 953-5. [Medline].

  5. Adamson PA. Nasal tip surgery in open rhinoplasty. Facial Plast Surg Clin North Am. 1993;1:39-52.

  6. 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. Nov 2004;114(6):1571-81; discussion 1582-5. [Medline].

  7. Daniel RK. Rhinoplasty: creating an aesthetic tip. A preliminary report. Plast Reconstr Surg. Dec 1987;80(6):775-83. [Medline].

  8. Gruber RP, Friedman GD. Suture algorithm for the broad or bulbous nasal tip. Plast Reconstr Surg. Dec 2002;110(7):1752-64; discussion 1765-8. [Medline].

  9. Johnson CM, Toriumi DM, eds. Open Structure Rhinoplasty. Philadelphia, Pa: WB Saunders Co; 1990.

  10. Kridel RW, Soliemanzadeh P. Tip grafts in revision rhinoplasty. Facial Plast Surg Clin North Am. Nov 2006;14(4):331-41. [Medline].

  11. Leach JL, Athre RS. Four suture tip rhinoplasty: a powerful tool for controlling tip dynamics. Otolaryngol Head Neck Surg. Aug 2006;135(2):227-31. [Medline].

  12. Lee KC, Kwon YS, Park JM, et al. Nasal tip plasty using various techniques in rhinoplasty. Aesthetic Plast Surg. Nov-Dec 2004;28(6):445-55. [Medline].

  13. Lo S, Rowe-Jones J. Suture techniques in nasal tip sculpture: current concepts. J Laryngol Otol. Aug 2007;121(8):e10. [Medline].

  14. McCollough EG, Mangat D. Systematic approach to correction of the nasal tip in rhinoplasty. Arch Otolaryngol. Jan 1981;107(1):12-6. [Medline].

  15. Romo T 3rd, Kwak ES, Sclafani AP. Revision rhinoplasty using porous high-density polyethylene implants to reestablish ethnic identity. Aesthetic Plast Surg. Nov-Dec 2006;30(6):679-84; discussion 685. [Medline].

  16. Sheen JH. Tip graft: a 20-year retrospective. Plast Reconstr Surg. Jan 1993;91(1):48-63. [Medline].

  17. Tebbetts JB. Shaping and positioning the nasal tip without structural disruption: a new, systematic approach. Plast Reconstr Surg. Jul 1994;94(1):61-77. [Medline].

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Further Reading

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Keywords

rhinoplasty, broad nasal tip, nose job, nasal surgery, bulbous nasal tip, rhinoplasty, narrowing of the nasal tip

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Contributor Information and Disclosures

Author

J Charlie Finn, MD, Assistant Consulting Professor of Surgery, Department of Surgery, Duke University
J Charlie Finn, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery and American Academy of Otolaryngology-Head and Neck Surgery
Disclosure: Nothing to disclose.

Medical Editor

Daniel G Becker, MD, Clinical Associate Professor, Department of Otorhinolaryngology-Head and Neck Surgery, Division of Facial Plastics and Reconstructive Surgery, University of Pennsylvania
Daniel G Becker, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American College of Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Dean Toriumi, MD, Department of Otolaryngology, Associate Professor, University of Illinois Medical Center
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Advanced Headache Intervention Consulting fee Consulting; Covidien Corp Consulting fee Consulting

 
 
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