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Background. Rhinoplasty is considered as one of the most challenging objectives in plastic surgery and tip rhinoplasty is arguably the greatest challenge for the surgeon performing rhinoplasty. No routine tip procedure is ever used and there are many ways to reconstruct and make nasal tips more attractive. Objective. The aim of this study was to evaluate the different correction techniques, in order to improve the outcomes in tip rhinoplasty. Methods. A prospective study was performed, including all patients with nasal tip deformities who underwent closed or open rhinoplasty between December 2015-August 2016 in Bombay Hospital, India. The patients were divided into two groups: group A – treated with various types of tip sutures (12 cases), and group B – treated with combined tip sutures and grafts (18 cases). Results. The study included 30 patients, 24 (80%) females and 6 (20%) males. 12 (40%) were patients with bulbous tips, 7 (23%) were patients with droopy tips, 5 (17%) were patients with boxy (broad) tips, 3 (10%) were patients with wide tips, and 3 (10%) were patients with bifid tips. A total of 27 (90%) cases involved primary rhinoplasties, and 3 (10%) cases involved revision. Patient’s and doctor’s satisfactions were recorded by a score from 0 to 3, with 0 being the less satisfied by the result of surgery and 3 being the highest satisfied. Conclusion. Aesthetic outcome following the management of nasal tips deformities with combined suture techniques and grafts is more satisfactory than the outcome that can be achieved following suture alone, especially in certain cases.

Résumé La connaissance approfondie de l’anatomie de la pyramide nasale est un prérequis indispensable à l’analyse pré-opératoire ainsi qu’à la compréhension des techniques chirurgicales. À l’image d’une tente soutenue par son armature, le nez correspond à une structure ostéo-cartilagineuse sur laquelle sont appliquées une enveloppe périchondro-périostée et des tissus de recouvrement musculaires et cutanés. Pour des raisons didactiques, nous avons choisi de traiter ce chapitre sous la forme de commentaires de huit schémas clés que le chirurgien devra avoir acquis avant la réalisation d’une rhinoplastie. Summary Thorough knowledge of the anatomy of the nose is an essential prerequisite for preoperative analysis and the understanding of surgical techniques. Like a tent supported by its frame, the nose is an osteo-chondral structure covered by a peri-chondroperiosteal envelope, muscle and cutaneous covering tissues. For didactic reasons, we have chosen to treat this chapter in the form of comments from eight key configurations that the surgeon should acquire before performing rhinoplasty. [ABSTRACT FROM AUTHOR]

Résumé: L’acide hyaluronique (AH) est le produit de comblement le plus utilisé à ce jour. Certaines complications liées à son utilisation ont été décrites, mais restent rares et bénignes. Nous rapportons ici un cas exceptionnel de nécrose cutanée de la pointe du nez, chez une jeune patiente de 22ans, faisant suite à une injection d’AH. L’aspect initial des lésions laissait présager des séquelles esthétiques considérables. Après mise à plat des tissus nécrosés, la patiente a été suivie de façon rapprochée. Des soins locaux quotidiens ont permis une cicatrisation dirigée, ne laissant que peu de séquelle par rapport aux lésions initiales observées. Cette complication rarissime nous rappelle que les injections d’AH ne sont pas dénuées de risque, malgré leur apparente simplicité d’utilisation. Par ailleurs, le cas présenté confirme le fort potentiel de cicatrisation de la pointe nasale, autorisant un traitement par cicatrisation dirigée, plutôt que tout autre geste invasif. [ABSTRACT FROM AUTHOR]

Summary: The complete dorsal nasal aesthetic unit can be raised in a vascular island flap based on the superior alar artery, at the level of the nasalis muscle. This flap uses the vertical glabellar cutaneous laxity. It hides scars between the nasal aesthetics units and its distal rotation point allows a pure translation of the nasal skin without distortions encountered when using medial canthal rotation flaps. This local flap is reliable and had been successfully used for four patients without complications or secondary procedures. It allows large reconstructions for up to 25mm defects leaving minimal scars. It represents an interesting alternative for the reconstruction of defects of the nasal tip or supra tip of the nose, and has also been used for alar reconstructions. [ABSTRACT FROM AUTHOR]

Thorough knowledge of the anatomy of the nose is an essential prerequisite for preoperative analysis and the understanding of surgical techniques. Like a tent supported by its frame, the nose is an osteo-chondral structure covered by a peri-chondroperiosteal envelope, muscle and cutaneous covering tissues. For didactic reasons, we have chosen to treat this chapter in the form of comments from eight key configurations that the surgeon should acquire before performing rhinoplasty., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Hyaluronic acid (HA) is the most used dermal filler. Some complications associated with its use have been described, but most of them are rare and benign. We report an exceptional case of skin necrosis of the tip of the nose, in a 22-year-old patient, after HA injection. The initial appearance may occurred subsequent aesthetic sequels. After necrotic tissue excision, patient was followed in rapid succession. Daily local care has led to wound healing, without any important sequel. This rare complication reminds us that HA injections are not without risk, despite their apparent simplicity of use. Moreover, the case presented confirms the potential healing of the nasal tip, allowing treatment with wound healing, rather than other early invasive procedure., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)