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Background: Nasal tip refinement is a challenging step of East Asian rhinoplasty due to complex anatomical defects. Autologous costal cartilage grafts are commonly used to provide nasal tip support. This study aims to evaluate the efficacy and safety of a modified technique using a lollipop-like cartilage graft with a peach-shaped head. Methods: A retrospective review was conducted on Chinese patients who underwent primary rhinoplasty with the modified technique between November 2018 and March 2021 at our center. Preoperative and postoperative facial photographs, patient-reported outcome measures including the visual analog scale (VAS) and the rhinoplasty outcome evaluation (ROE), as well as surgery-related complications, were collected for outcome assessment. Results: A total of 31 adult patients were included in this retrospective cohort study, with a mean follow-up period of 17.12 ± 3.89 months. The majority of patients (28/31; 90.3%) expressed satisfaction with the aesthetic outcomes, as evidenced by a significant increase in mean VAS score from 3.97 ± 1.52 preoperatively to 7.39 ± 0.22 postoperatively (P < 0.01), and a significant increase in mean ROE score from 11.77 ± 2.33 to 17.22 ± 2.47 (P < 0.01). Photogrammetric analysis also demonstrated significant improvements in nasal anatomical measurements. Among the three patients with unsatisfactory feedback, two had mild columella deviations and one had a mild dorsum deviation. No other notable complications were reported. Conclusion: The current study supports the safety and utility of the modified technique utilizing the lollipop-like costal cartilage graft with a peach-shaped head for major tip refinement in East Asian patients. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

IntroductionThis study explores the profound impact of nasal structure on individuals' self-image and emotional well-being, emphasizing the increasing popularity of rhinoplasty in Saudi Arabia, influenced by societal beauty standards portrayed on social media. The investigation aims to unravel the complex interplay between demographic factors, such as gender and age distribution, and prevalent nasal deformities in a cohort of 293 participants.Material and methodsThis retrospective study at the University of Hail and King Khalid Hospital, Saudi Arabia, investigated nasal deformities in 293 participants aged 15–54. Ethical approval was obtained, and data, including bio-demographics and nasal deformities, were retrospectively reviewed. Statistical analyses, utilizing chi-square and Fisher exact tests, assessed associations, enhancing internal validity. The study targeted a diverse population, emphasizing ethical guidelines and systematic sampling.ResultsOur study of 293 participants revealed a prevalence of common nasal deformities. Dorsal hump deformity (59.0%) was the most prevalent, followed by external nasal deviation (54.6%). Significant gender differences were observed, with males more prone to external nasal deviation (65.6%), while decreased nasal tip rotation was more common in females (40.6%). Variations in nasal tip shape were statistically significant, with broad nasal tip shape more prevalent in females (35.2%).ConclusionIn conclusion, our study highlights the prevalence of common nasal deformities, emphasizing significant gender variations. These findings contribute to a deeper understanding of nasal anatomy, essential for informed decision-making in rhinoplasty.

Background: Control of nasal tip position is critical to final rhinoplasty outcomes. Two frequent methods of exerting tip control are columellar strut and caudal septal extension graft (SEG). Past work has demonstrated that SEG are better able to preserve tip position. However, there is no quantitative data describing long-term projection and rotation. The purpose of this study was to analyze long-term maintenance of tip projection and rotation following SEG. Methods: A retrospective study of adult patients undergoing open rhinoplasty was conducted. Three-dimensional photogrammetric evaluation of nasal tip position was performed. Anthropometric points were analyzed preoperatively and postoperatively. Outcome variables were tip projection, tip rotation, and nasal length. Results: Twenty patients were included with an average follow-up time of 3.3 years (2.0 – 6.6 years). From postoperative week 1 to 6, there was a statistically significant decrease in rotation (−4.3%, p<0.01). There were no statistically significant decreases in projection, rotation, or nasal length from 6 weeks postoperative to 2 years postoperative, or from 6 weeks postoperative to final follow-up (2.0 – 6.6 years). Conclusions: Nasal tip projection and rotation appear to decrease from the immediate postoperative position, likely due to resolving edema. In this study, patients that underwent open rhinoplasty with SEG experienced modest loss of projection and rotation until 6 weeks postoperative, but projection and rotation were maintained from 6 weeks postoperative to 2 years and beyond. This study provides evidence that SEG maintains long-term changes in tip projection and rotation. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Nasal tip surgery is an important component of rhinoplasty and it is a challenging issue including creating an ideal or aesthetical tip rotation and projection and keeping it during the long term. Columellar strut graft (CSG) and septal extension graft (SEG) are current and valid major surgical techniques that provide nasal tip support. Dom extension graft (DEG), which is a modification of SEG, aims to create a structure resistant to the forces loaded on the type supports in the long term by transferring the forces to columellar strut graft (CSG). Level of evidence: Level IV, Therapeutic study [ABSTRACT FROM AUTHOR]

Objective: To evaluate the influence of variations in the upper sulcus depth, nasal tip protrusion, and nasolabial angle on the esthetic perception of profiles. Design: A web-based survey study and was conducted in the Department of Orthodontics and Dentofacial Orthopaedics. This survey was conducted for a period of 10 months and included orthodontists practicing in India. Methods: This study included lateral cephalograms of the most esthetic profiles from a set of 30 profiles that were within Holdaways norms; the most esthetic profile was determined by a panel of two orthodontists and two general dentists. The most esthetic profile photograph will be transferred to a computer in Corel software. The outline of the profile will remain the same, with the inner aspect converted into a dark area (black); now, the profile is completely converted into facial silhouettes. This black facial silhouette is presented to avoid any distractions and bias. There will be a total of 27 silhouettes by various combinations of increased, decreased, and normal values for nasolabial angle, upper sulcus depth, and nasal tip protrusions. Results: Both the orthodontist and layman chose the most favored profile as a normal profile having a normal nasal tip, normal nasolabial angle, and normal upper sulcus depth, whereas among dentists, 50% chose the most favored profile in which the nasolabial angle was normal but the nasal tip and upper labial sulcus were decreased. When it comes to the least favored profiles, opinions varied between orthodontists, dentists, and laymen. Conclusion: The perception of facial esthetics has always been and still is varied between the layman, the dentist, and the orthodontists. Profiles with normal to sharp noses with normal and increased nasolabial angles were considered more attractive than the others. Profiles with fuller upper labial sulci were considered least attractive with other parameters changing. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the influence of variations in the upper sulcus depth, nasal tip protrusion, and nasolabial angle on the esthetic perception of profiles. Design: A web-based survey study and was conducted in the Department of Orthodontics and Dentofacial Orthopaedics. This survey was conducted for a period of 10 months and included orthodontists practicing in India. Methods: This study included lateral cephalograms of the most esthetic profiles from a set of 30 profiles that were within Holdaways norms; the most esthetic profile was determined by a panel of two orthodontists and two general dentists. The most esthetic profile photograph will be transferred to a computer in Corel software. The outline of the profile will remain the same, with the inner aspect converted into a dark area (black); now, the profile is completely converted into facial silhouettes. This black facial silhouette is presented to avoid any distractions and bias. There will be a total of 27 silhouettes by various combinations of increased, decreased, and normal values for nasolabial angle, upper sulcus depth, and nasal tip protrusions. Results: Both the orthodontist and layman chose the most favored profile as a normal profile having a normal nasal tip, normal nasolabial angle, and normal upper sulcus depth, whereas among dentists, 50% chose the most favored profile in which the nasolabial angle was normal but the nasal tip and upper labial sulcus were decreased. When it comes to the least favored profiles, opinions varied between orthodontists, dentists, and laymen. Conclusion: The perception of facial esthetics has always been and still is varied between the layman, the dentist, and the orthodontists. Profiles with normal to sharp noses with normal and increased nasolabial angles were considered more attractive than the others. Profiles with fuller upper labial sulci were considered least attractive with other parameters changing.

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Introduction: Acute angle between dome and ala causes alar concavity/pinch deformity. Breathing problems may accompany pinching. Here, pinch deformities were classified according to their severity and treatment modalities discussed. Materials and Methods: Rhinoplasty patients with pinch deformities were included in study. Pinching without external nasal valve blockage (ENVB) was classified mild, pinching with ENVB was classified moderate, and extreme pinching and ENVB were classified severe deformity. In mild deformity, cephalic resection of ala was performed or cephalic resection was combined with onlay graft over ala. In moderate deformity, cephalic part was bent and sutured over lower ala. In severe deformity, cephalic part was bent, and lateral strut graft was inserted between lower and cephalic ala. In pinch deformities combined with hypertrophic lower lateral cartilage (LLC), medial crural overlay preceded above-mentioned treatment modalities. Results: Thirty-eight patients (22 female, 16 male) with pinch deformities underwent rhinoplasty between January 2017 and December 2022. Mean age was 27 years. Mean follow-up was 32 months. Fifteen patients had mild deformities. Cephalic resection was enough in four patients. Camouflage grafts were settled over ala in eleven patients. Twenty patients had moderate deformities; cephalic ala was bent over lower part and sutured. Two patients had severe deformities; lateral strut graft was settled between lower and bent cephalic alar parts. One patient had LLC hypertrophy/pinch deformity. LLC hypertrophy was corrected by medial crural overlay, and concavity was corrected with cephalic resection. Satisfactory shape, better valve passage obtained in all cases. Conclusion: Pinch deformity could be classified according to its severity and appropriate treatment options could be determined for each class. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/journal/00266. [ABSTRACT FROM AUTHOR]

A 65-year-old man presented with a Melanoma in situ of the nasal tip. Complete excision was achieved after 2 “Slow Mohs” stages, resulting in a circular 2.7 X 2.4 cm defect involving the right lateral nasal tip, dorsum and sidewall and extending to the perichondrium.

Songting Li,1,2 Xiaolan Cai,3 Keyao Yu,1,2 Weihua Pan1,2 1Department of Dermatology, Second Affiliated Hospital of Naval Medical University, Shanghai, People’s Republic of China; 2Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai, People’s Republic of China; 3Department of Otorhinolaryngology, Qilu Hospital of Shandong University, Jinan, People’s Republic of ChinaCorrespondence: Weihua Pan, Department of Dermatology, Second Affiliated Hospital of Naval Medical University, Shanghai, People’s Republic of China, Tel +86-2188485495, Email panweihua9@sina.comBackground: Cutaneous metastasis is rare in clinical practice, especially that from primary hepatocellular carcinoma (HCC), which is even rarer.Case Presentation: This report describes a male patient with HCC with cutaneous metastases to the nasal tip. The patient developed a raised nodule at the nasal tip 5 years after surgery for HCC, with surface ulceration and crusting and no obvious symptoms. Abdominal computed tomography (CT) showed an obvious mass in the liver. The skin lesions on the nasal tip were confirmed to be cutaneous metastasis of HCC by histopathological and immunohistochemical examinations.Conclusion: The incidence of cutaneous metastasis of HCC is extremely low, and nasal tip cutaneous metastasis of HCC has no specific clinical manifestations; therefore, it needs to be distinguished from rosacea rhinophyma, fungal and atypical mycobacterial infections, tumours of vascular origin, and tumours of skin appendages that occur in the nasal tip and is prone to misdiagnosis and missed diagnosis, thus requiring clinical dermatologists and otolaryngologists to be aware of such metastasis.Keywords: primary, hepatocellular carcinoma, metastatic cancer, skin, nasal tip

Enhancing nasal tip projection is an important objective in Asian rhinoplasty. Nasal tip enhancement using auricular cartilage is simple and suitable for Asian patients. However, the long-term retraction problem of the auricular framework still needs to be solved for optimal results. The authors propose a modified auricular cartilage framework construction technique that provides stronger long-term support to the nasal tip and columellar base. Eighty-one patients underwent augmentation rhinoplasty between January 2016 and December 2019. The cymba and cavum conchae were harvested from one ear in all cases. The cymba concha was carved and folded to form a caudal septal extension graft (CSEG). The cavum concha was divided into an integrated cap/shield graft and a columella base graft. The columella base graft was diced into particles in size of 1 mm3, and inserted into the gap between CSEG, anterior nasal spine, and the medial crus to strengthen the foundation. The nasal profile was analyzed before the operation and at least 12 months after the operation. The patient satisfaction score was assessed 12 months after surgery. Patients were followed up for 12–36 months. The nasal tip projection from both the lateral and basal views was significantly improved. The columella–labial angle was increased from 83.15° (6.20°) to 96.50° (7.40°) (p < 0.05). The nostril tip proportion increased from 0.83 (0.14) to 1.17(0.16) (p < 0.01). A stable long-term outcome was achieved. With the modified framework construction technique, long-term nasal tip drooping can be prevented. This method can be a practical choice for Asian patients seeking augmentation rhinoplasty. [ABSTRACT FROM AUTHOR]

Objective:Correction of nasal tip projection (NTP) deformities involve techniques for the lower lateral cartilage of the nose. Previously, it would have been surgically difficult to perform the lateral crural overlay (LCO) technique for the second time in revision rhinoplasty in patients who already had undergone rhinoplasty with the LCO technique because of the length of the NTP. In this study, we evaluated the lateral crural segmental excision (LCSE) technique in patients with overprojected nasal tip in revision rhinoplasty.Methods:We retrospectively studied the cases of 19 patients who had initially undergone rhinoplasty with the LCO technique for overprojected nasal tip, and later underwent revision rhinoplasty with the LCSE technique after insufficient NTP was observed on facial analysis between 2018 and 2022.Results:Of the patients, 12 (63%) were male, with an average age of 29.6 years, and 7 (17%) patients were female, with an average age of 25.3 years. Using Goode’s formula, NTP indexes of patients measured 79.4±1.8 preoperatively and 56.0±1.3 postoperatively. Stastically significant difference was observed between preoperative and postoperative values. None of the patients had malnutrition at the incision margins, and all patients recovered on time and without any problems. Granulation tissue was detected in the mucosa in only one patient.Conclusion:The LCSE technique, with a short surgical time, recovery period without complications, and satisfactory nasal respiratory function, is preferred over a second LCO application in cases of NTP.

Introduction: Mohs Micrographic Surgery (MMS) is a treatment option for high-risk facial nonmelanoma skin cancer with high cure rates. Especially on the nasal tip, the tissue sparing properties of MMS are appealing. The nasal tip is a common location of nonmelanoma skin cancer and can be a challenging anatomical structure for reconstructive surgery due to its prominent location in the face, the shortage of spare tissue, as well as the stiffness and composition of different skin types, cartilage and bone. Objectives: The aim of the present paper is to review and demonstrate how reconstruction of the nasal tip can be done successfully to improve the care for patients undergoing MMS in this area. Methods: Using selected literature on the area and the surgeons experience, each method of repair are described including their individual advantages and challenges. Pictures and consent were selected from one patient who underwent each repair method and three photos are presented in this paper: one after tumor resection, one immediately after repair, and one minimum 6 months post-surgery. Results: We present eight surgical methods as well as pictures from previous surgeries. Conclusions: The results demonstrate obtainable results using very different surgical methods and the importance of an individualized approach to repairing cutaneous defects of the nasal tip.

Guangdong Wen, Dandan Mao, Mengyi Zhu, Jian Hu, Xueyan Yao, Jianzhong Zhang Department of Dermatology, Peking University People’s Hospital, Beijing, People’s Republic of ChinaCorrespondence: Jianzhong Zhang, Department of Dermatology, Peking University People’s Hospital, No. 11 Xizhimen South Street, Beijing, 100044, People’s Republic of China, Tel +86-10-88325472, Email rmzjz@126.comPurpose: To investigate the cosmetic outcomes of secondary intention healing of small (< 1.5cm) nasal ala and tip defects.Patients and Methods: From August 2017 to October 2020, 42 patients with nasal reconstructions using secondary intention healing were included. Defects after excision ranged from 0.5cm× 0.7cm to 1.2cm× 1.5cm in size. Foam dressing covering the wounds was changed every 3 to 5 days. Wound esthetic outcomes were graded as excellent, good, acceptable, and poor based on definitions described in the literature.Results: All 42 wounds healed in 3 to 4 weeks, with uniform color, no obvious adverse reactions and high patient satisfaction. Esthetic evaluation: 16 excellent cases (38.1%), 19 good cases (45.2%), 7 acceptable cases (16.7%) and 0 poor cases.Conclusion: Secondary intention healing of small nasal tip and ala defects in Chinese yielded satisfactory esthetic outcomes and should be an integral part of the surgeon’s reconstructive algorithm.Keywords: nasal tip, ala, secondary intention healing, foam dressing

Background and objective. Plastic surgeons who perform rhinoplasty face with patients with different characteristics depending on their ethnicity. Among the strategies implemented for these patients, the use of isotretinoin has been described for the management of thick skin. Currently, there are multiple gaps in the literature regarding the benefit and associated complications of this type of treatment in rhinoplasty The objective of this study is to review the evidence available in the literature on the benefits and risks derived from the use of isotretinoin and rhinoplasty. Methods. A scoping review of the literature was developed on data base: PubMed Central (PMC), Cochrane, Sciencie Direct, Taylor and Francis Databases using Mesh terms "Rhinoplsaty AND Isotretinoin". The articles were evaluated and classified to identify the available evidence in English and Spanish. Results A review of 2621 articles published on different databases between January 2005 and June 2022 was performed, and 13 articles met the criteria established by the researchers for their analysis: 5 case reports, 2 narrative reviews, 2 controlled trials, 1 expert consensus, 1 case and control, 1 multicenter study, and 1 systematic review of the literature. Conclusions. Isotretinoin is a safe drug in concomitant use with facial procedures such as rhinoplasty and generates favorable aesthetic results in patients with a thick-skinned nose in the first 6 postoperative months. However, its use must be analyzed individually in every case since it can produce adverse effects such as dry skin and excessive thinning of the nasal skin. [ABSTRACT FROM AUTHOR]

Objective: Correction of nasal tip projection (NTP) deformities involve techniques for the lower lateral cartilage of the nose. Previously, it would have been surgically difficult to perform the lateral crural overlay (LCO) technique for the second time in revision rhinoplasty in patients who already had undergone rhinoplasty with the LCO technique because of the length of the NTP. In this study, we evaluated the lateral crural segmental excision (LCSE) technique in patients with overprojected nasal tip in revision rhinoplasty. Methods: We retrospectively studied the cases of 19 patients who had initially undergone rhinoplasty with the LCO technique for overprojected nasal tip, and later underwent revision rhinoplasty with the LCSE technique after insufficient NTP was observed on facial analysis between 2018 and 2022. Results: Of the patients, 12 (63%) were male, with an average age of 29.6 years, and 7 (17%) patients were female, with an average age of 25.3 years. Using Goode's formula, NTP indexes of patients measured 79.4±1.8 preoperatively and 56.0±1.3 postoperatively. Stastically significant difference was observed between preoperative and postoperative values. None of the patients had malnutrition at the incision margins, and all patients recovered on time and without any problems. Granulation tissue was detected in the mucosa in only one patient. Conclusion: The LCSE technique, with a short surgical time, recovery period without complications, and satisfactory nasal respiratory function, is preferred over a second LCO application in cases of NTP. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To present a rare case of nasal tip schwannoma and describe its resection and reconstruction using combined cartilage grafts. Methods: Design: Case Report Setting: Tertiary Government Training Hospital Patient: One Results: A 13-year-old boy presented with a progressively enlarging nasal tip and severe left nasal obstruction causing breathing difficulties and psychosocial distress. There was a bulging septal mass obstructing 90% of the left nasal cavity. Septal incision biopsy revealed schwannoma and definitive surgery via open rhinoplasty approach was done. The non-encapsulated schwannoma extended from the subcutaneous nasal tip to the left septal mucosa. There was no evidence of skin or cartilage invasion, but prolonged pressure from the expansile schwannoma caused severe lower lateral cartilage and anterior septal atrophy leading to a collapsed and expanded nasal tip after resection. To correct this, a total reconstruction of the anterior tip complex was done using combined ear cartilage seagull wing graft, shield graft and septal extension graft. Conclusion: Nasal tip and septal schwannoma is rare and can cause significant nasal obstruction and deformity. Complete excision is vital to avoid recurrence. Total reconstruction of the lower lateral cartilages using autologous septal and ear cartilage grafts may be a safe and effective technique that yields acceptable aesthetic results.

Le Fort I osteotomy causes nasolabial alterations that may be unattractive, such as expansion of the alae and alar bases and thinning of the upper lip. After maxillary impaction, there is a propensity for the tip to elevate, and in some circumstances, this may even become excessive. The nasolabial angle closes and similar alterations are observed with maxillary advancement. When Le Fort I impaction or maxilla advancement occurs, the alar base cinch suture is frequently utilised to reduce the unfavourable rise in nasal width. There are significant changes in the nasolabial morphology associated with Le Fort I osteotomy. Numerous changes occur after the surgical intervention in the maxilla namely- widening of the alar base of the nose, upturning of the nasal tip, flattening and thinning of the upper lip and down turning of the commissures. Widening of the alar bases of the nose appears to be the most common undesirable outcome. Some people may benefit aesthetically from nasal widening. For instance, the long face syndrome is frequently characterised by a narrow nose with a large dorsum. In these situations, superior maxillary relocation typically improves the look of the nose by enlarging the bases of the arches. However, excessive alar base broadening and superior retraction would cause the alar-facial groove to aesthetically deepen, giving the patient an older appearance, and may cause asymmetry in the alas. It is crucial for the surgeon to comprehend the preoperative aesthetic facial linkages and anticipate any potential impact the surgical operation may have on the nasolabial region before performing maxillary surgery. To control the width of the alar base after maxillary osteotomy clinicians have advocated the placement of cinch sutures, reduction of the anterior nasal spine and use of V-Y closure technique. There are inconstant opinions on the effect of the cinch suture.

Background: Reconstruction of nasal tip defects is challenging due to the prominence of the nose and scarce local tissue. There are several well-known local flaps for tip reconstruction. The Rintala flap, a sliding axial musculocutaneous flap from the nasal dorsum, can be used without distorting adjacent tissues and preserves the nasal subunit's integrity. Although other case series confirmed viability and proposed modifications, patient-reported outcome measures (PROMs) have not been previously reported.We set out to confirm the suitability of the Rintala flap for the reconstruction of nasal (supra) tip defects and describe patient satisfaction with this specific reconstruction. Methods: We present a case series involving 38 patients from two Dutch centers between 2010 and 2020. After tumor excision on the nasal tip or dorsum, defects were reconstructed using the Rintala flap. Patient-reported outcome measures (PROMs) were collected using the FACE-Q skin cancer module, evaluating various aspects of health-related quality of life. Results: There were no cases of flap necrosis, tip rotation, or glabellar flattening in this series. FACE-Q scores showed high overall satisfaction with facial appearance and scars. Conclusions: The Rintala flap should be considered a reconstructive option for patients with defects of the nasal dorsum up to 1.5 cm in size, particularly for patients who desire elevation of the nasal tip. It is a simple, one-step procedure that produces reliable aesthetic results and leaves the forehead intact as a donor site for future reconstruction.The Rintala flap has distinct advantages in reconstructing nasal tip defects with excellent FACE-Q scores. Level of evidence: Level IV, therapeutic / prognostic study [ABSTRACT FROM AUTHOR]

Objectives: Main properties of nasal tip are the nasal tip projection (NTP), the nasal tip rotation (NTR), and the definition. Its surgery is difficult due to anatomic variations, pathologies, and various surgery possibilities. The ideal technique must also provide good results in long-term. The aim of the study was to analyze long-term results of vertical alar resection (VAR) technique in rhinoplasty. Methods: Forty-eight patients who underwent rhinoplasty operations that VAR method was used by senior author between 2001 and 2017 were included into the study (42 women and six men). The mean age of patients was 35.5 years (range 18-56 years). Mean post-operative follow-up period was 86.8 months (range 25-225 months). We analyzed pre=operative, early, and late postoperative photographs of patients. NTP and NTR changes in years were objectively evaluated. Patients also completed Rhinoplasty Outcome Evaluation questionnaire in their last control visit. Results: Mean NTP (through Goode Method) was changed from 0.60 in early to 0.59 in late post-operative control, mean nasofacial angle from 29.4 in early to 28.7 in late post-operative control. Mean nasolabial angle (NLA) changed from 97.3 to 94.5 and Tip rotation angle (TRA) from 35.2 to 35.4 between early and late post-operative control. Differences between early and late post-operative measures of NTP and NLA were significant (p<0.001 for all), but TRA did not changed significantly (p>0.001). Conclusion: VAR is a useful method for modifications of lateral crura and nasal tip. With VAR, we can control NTP and NTR, length of lateral crus and nose; get satisfying and long lasting results. [ABSTRACT FROM AUTHOR]

Nasal tip management is considered to be one of the most complicated and challenging parts of rhinoplasty in East Asian patients. Within current rhinoplasty surgical practice, costal cartilage serves as an ideal source for grafting due to its ability to provide strong support to the nasal tip. From March 2013 to December 2021, integrated clip-shaped costal cartilage grafts were applied to patients with primary (n = 12) or secondary (n = 3) short nose deformities. The costal cartilage was carved into an monobloc clip-shaped cartilage graft and then placed on the nasal septum and fixed with sutures. The nasal length index, projection index, and nasolabial angles were measured preoperatively and postoperatively. Postoperative evaluation at 8 months was performed using a grading scale. A total of 15 patients were included in this study with an average age of 23.7 ± 3.6 years. The mean follow-up period was 14.3 ± 5.3 months and ranged from 8 to 26 months. There were statistically significant differences between the preoperative and postoperative values in nose length index and projection index. Also, the nasolabial angle was significantly reduced. Postoperative evaluation, conducted at a minimum of 8 months following surgery, showed that 86.6% (13/15) of patients felt that their surgical results were good or excellent. No patients rated the results as "poor". The integrated clip-shaped costal cartilage carving approach has been shown to be a practical method of obtaining satisfactory esthetic outcomes in patients with nasal deformities. [ABSTRACT FROM AUTHOR]

Introduction: Replacing the skin along the nasal tip remains a challenge. Depending on the extent of the skin loss, various local or regional flaps are available for reconstruction. If cutaneous replacement involves the nasal tip, the forehead flap can be used successfully. However, it requires a multistage procedure and can leave considerable scarring on the patient's forehead. As an alternative, the authors present the free style "Twin V/Y Nasal Perforator Flaps" (TVYNPF), which can be used as a one-stage procedure for nasal tip reconstruction., Material and Methods: A series of five patients aged between 69 and 89 years with extensive basal cell carcinomas at the nasal tip is presented. The surgical procedure is explained in detail. The follow-up period ranged from 8 to 12 months., Results: Healing was uneventful for all five patients, and the shape, symmetry, and aesthetical unity of the nasal tip and the alae of the nose were preserved in all patients, without any functional impairment. All scars presented inconspicuously., Conclusion: In the selected patients, the free style TVYNPF proved to be a good alternative to the forehead flap for one-stage reconstruction of significant skin loss along the nasal tip, while preserving the esthetics and function of the nose., Competing Interests: Declaration of Competing Interest There are no conflicts of interest including employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, and grants or other funding., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Introduction: This study explores the profound impact of nasal structure on individuals' self-image and emotional well-being, emphasizing the increasing popularity of rhinoplasty in Saudi Arabia, influenced by societal beauty standards portrayed on social media. The investigation aims to unravel the complex interplay between demographic factors, such as gender and age distribution, and prevalent nasal deformities in a cohort of 293 participants., Material and Methods: This retrospective study at the University of Hail and King Khalid Hospital, Saudi Arabia, investigated nasal deformities in 293 participants aged 15-54. Ethical approval was obtained, and data, including bio-demographics and nasal deformities, were retrospectively reviewed. Statistical analyses, utilizing chi-square and Fisher exact tests, assessed associations, enhancing internal validity. The study targeted a diverse population, emphasizing ethical guidelines and systematic sampling., Results: Our study of 293 participants revealed a prevalence of common nasal deformities. Dorsal hump deformity (59.0%) was the most prevalent, followed by external nasal deviation (54.6%). Significant gender differences were observed, with males more prone to external nasal deviation (65.6%), while decreased nasal tip rotation was more common in females (40.6%). Variations in nasal tip shape were statistically significant, with broad nasal tip shape more prevalent in females (35.2%)., Conclusion: In conclusion, our study highlights the prevalence of common nasal deformities, emphasizing significant gender variations. These findings contribute to a deeper understanding of nasal anatomy, essential for informed decision-making in rhinoplasty., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Alotaibi, Alsuwayt, Raghib, Alsayer, Albarrak, Alrasheedi, Saleem, Afreen and Friedman.)

This study investigated the relationship between the direction of maxillary repositioning after Le Fort I osteotomy and changes in external nasal morphology using lateral cephalograms and frontal facial photographs. The results indicated greater changes in external nasal morphology, such as a more forward position of the nasal tip and an increased alar base width, with anterosuperior repositioning than with posterosuperior repositioning. In conclusion, this study demonstrated that the external nasal morphology changes after Le Fort I osteotomy, and that the changes vary depending on the direction of maxilla repositioning. [ABSTRACT FROM AUTHOR]

Different techniques exist to provide tip support in rhinoplasty. There is little evidence to provide a consensus on the most effective choice. Evaluating columellar strut graft (CSG) and septal extension grafts (SEG) for their influence on airway function, patient satisfaction and tip support. A retrospective cohort study was undertaken on 165 adult patients who underwent open rhinoplasty with either a CSG or SEG, from February 2012 to August 2019 in a single tertiary facial-plastic practice in Sydney, Australia. Operations were for both cosmetic and functional indications, and both primary and revision cases were assessed. Airway testing and patient-reported outcomes (PROMs) were performed preoperatively and at least 6 months following the procedure. Photographic tip analysis was taken from approximately 4 and 12-month postoperative photographs. Nasal peak inspiratory flow (NPIF) and total nasal airway resistance (NAR) were the primary airway functional outcomes. The primary PROMs analysed were a visual analogue scale (VAS) for nasal obstruction and 13-point Likert scale for global cosmesis, the Nose Outcome Symptom Evaluation (NOSE), and the nasal obstruction score. Tip support was determined by the nasolabial angle (NLA) and Simon's ratio as assessed by Rhinobase developed by Apaydin et al. on lateral Frankfort plane photographs. Data normalised as an improvement over preoperative baseline, accounting for individual variability. A total of 165 patients was assessed (35.2 ± 12.9 yrs, 72% female), 100 (61%) of which received SEG. There were similar nasal airway assessments between CSG and SEG groups, with ΔNPIF (20.0 ± 42.1 L/min v 19.9 ± 44.9 L/min, p = 0.983) and Δ "obstructed" NAR (-1.13 ± 1.90 v -1.02 ± 4.33 Pa/cm3/s, p = 0.849). Amongst PROMs, a greater cosmetic outcome was seen in the SEG group (7.20 ± 2.97 v 5.69 ± 3.45, p < 0.01) with all other assessments similar between CSG and SEG techniques. Photographic analysis of tip projection showed reduced NLA distortion in the SEG. While greater patient-perceived cosmesis was seen in patients with a SEG, there were similar airflow and patient-reported nasal function between groups. Photographic analysis of tip projection showed SEG patients additionally benefited from less NLA distortion and greater tip maintenance. [ABSTRACT FROM AUTHOR]

Despite the great demand of aesthetic rhinoplasty in Asian population, it is difficult to obtain the lasting ideal tip projection along with lengthening of the nose due to the small and weak nasal septum. The shortage of available septal cartilage to work with is another major obstacle. A retrospective study was conducted between January 2017 and December 2019 in Seoul, Korea. A total of 774 patients underwent septorhinoplasty using polycaprolactone (PCL) mesh for the cosmetic enhancement of the nasal tip and the projection. Comparisons of aesthetic outcomes, patients' satisfaction surveys, and complications were performed between PCL mesh-only group and composite PCL group. Of all the patients, 97.5% of the patients in composite PCL group were rated more than 3 scores in aesthetic outcomes, whereas 90.4% in mesh-only group ( p -value = 0.0002). About 96.7% of the patients with composite PCL rated their satisfaction level as more than satisfied, whereas 94.3% in mesh-only group ( p -value = 0.0365). Overall, there were 17 patients in composite PCL group who exhibited complications including decreased tip projection, deviated nasal tip, mesh infection, and mesh exposure. However, there were two patients who had mesh injection in mesh-only group. Septorhinoplasty with septal extension graft using composite PCL graft provides robust support to the aesthetically modified projection and the lengthened nose without obvious complications on the nasal tip. Such technique allows surgeons to overcome the nature of Asian nose that is weak and small, and also provides satisfaction to patients who desire ideal tip projections and dramatic changes. [ABSTRACT FROM AUTHOR]

Gaining, improving, and maintaining nasal tip projection is one of the most essential elements of successful endonasal rhinoplasty. For years the hallmark of inadequate nasal tip projection following rhinoplasty has been the Polly beak deformity. Early rhinoplasty technique consisted of intracartilaginous excision of the cephalic margin of the lower lateral cartilages, cartilage and bony hump reduction, and osteotomies. Some of these simple rhinoplasties still look good decades later, however, many are conspicuous in their lack of nasal tip projection. The reason for this inconsistency in rhinoplasty results was the surgeon's inattention to the structural integrity and anatomical position of the LLC. The senior author uses a combination of suture, strut, and cartilage grafting techniques to achieve ideal projection in a manor tailored to each patient's unique anatomic needs. [ABSTRACT FROM AUTHOR]

Le Fort I osteotomy causes nasolabial alterations that may be unattractive, such as expansion of the alae and alar bases and thinning of the upper lip. After maxillary impaction, there is a propensity for the tip to elevate, and in some circumstances, this may even become excessive. The nasolabial angle closes and similar alterations are observed with maxillary advancement. When Le Fort I impaction or maxilla advancement occurs, the alar base cinch suture is frequently utilised to reduce the unfavourable rise in nasal width. There are significant changes in the nasolabial morphology associated with Le Fort I osteotomy. Numerous changes occur after the surgical intervention in the maxilla namely-widening of the alar base of the nose, upturning of the nasal tip, flattening and thinning of the upper lip and down turning of the commissures. Widening of the alar bases of the nose appears to be the most common undesirable outcome. Some people may benefit aesthetically from nasal widening. For instance, the long face syndrome is frequently characterised by a narrow nose with a large dorsum. In these situations, superior maxillary relocation typically improves the look of the nose by enlarging the bases of the arches. However, excessive alar base broadening and superior retraction would cause the alar-facial groove to aesthetically deepen, giving the patient an older appearance, and may cause asymmetry in the alas. It is crucial for the surgeon to comprehend the preoperative aesthetic facial linkages and anticipate any potential impact the surgical operation may have on the nasolabial region before performing maxillary surgery. To control the width of the alar base after maxillary osteotomy clinicians have advocated the placement of cinch sutures, reduction of the anterior nasal spine and use of V-Y closure technique. There are inconstant opinions on the effect of the cinch suture. [ABSTRACT FROM AUTHOR]

Background: A solid tip support plays the fundamental role in augmentation rhinoplasty for East Asians. However, the soft tissue envelope is sometimes limited; the bilateral alae and mucosae cannot be transposed to consolidate the full course of the strut. A graft that serves for the ultimate purpose of elongating the valid length of the strut is therefore necessary. Methods: Forty-one female patients, ranging in age from 19 to 35 years (average 26.5 years), received augmentation rhinoplasty surgery that was supplemented by the applications of the bilateral accessory add-on tip grafts. The tip projection was established by columellar strut or septal extension grafts. These crescent-shaped grafts acted like a bridge between the alae and the strut, which aim to provide supplementary volume and surface area to help reduce tension and further define the width and shape of the nasal tip. Results: Patients' own evaluations on the overall improvements of the nose rendered high satisfaction rate. During the follow-up, six cases presented deviated columella and asymmetrical nostrils; three cases had deformed dorsal profile due to graft warping or resorption at 12 to 18-month period postoperatively, and were corrected during revision surgeries. No other major complications were encountered. Conclusions: These accessory tip add-on grafts are intrinsically applicable for East Asians rhinoplasty surgeries. Instead of being utilized as a routine graft for normal circumstances, this pair of accessory tips is an expedient measure to solve a difficult situation. This graft will be particularly necessary in managing a severely short nose with interior soft tissue insufficiency. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Septal extension graft is a unique technique for controlling nasal lengthening and tip projection, rotation, and shape by which a graft is fixed to the septum, leading to a strong and stable supporting structure. Nasal tip three-dimensional positioning is a vital and difficult component in the overall appearance of the tip. A total of 12 Middle Eastern patients with thick nasal envelope skin were subjected to rhinoplasty using the septal extension graft (SEG) method. Eleven out of the 12 patients, had pleasing results after primary rhinoplasty with SEG, while only one patient had SEG as a secondary procedure. In conclusion, septal extension graft in rhinoplasty is an effective technique for achieving a strong supporting force of the nasal tip for adequate projection. Keywords: Nasal tip, surgery, septal extension, graft, rhinoplasty

The authors propose a novel flap for rhinoplasty: the supratip cross flap (SCF). It is a simple and effective method for avoiding and correcting alar contour deformities and external nasal valve (ENV) issues in rhinoplasty without grafts. In addition to its benefit for supratip break, the flap also allows a smooth and natural transition between the nasal dorsum and the nasal tip complex.

Introduction The predictability of nasal tip projection and rotation after aesthetic surgery is a challenge. Tongue-in-groove (TIG) is an effective technique to control tip projection and rotation, but there may be a small loss of projection and rotation of the tip lobe due to lack of support between the anterior septal angle and the domus, since this region is sustained by medial crusts suture-linked and interdomus sutures. Objective To describe a new surgery technique in an attempt to correct the lack of support for the nasal tip after lowering the nasal dorsum. Methods The horn technique consists in preserving a square of cartilage during the removal of the nasal dorsum and septum excess in patients with long and projected nose. This piece will give greater support to the TIG technique and greater predictability of the rotation and projection of the nasal tip. Results Between 2016 and 2018, 50 patients with long and projected noses were submitted to the “horn technique” surgery. They were submitted to the TIG technique associated to the horn technique. A retrospective review of the preoperative and postoperative photographs (3 months to 1 year) of these patients treated with the horn technique were analyzed and showed better support of the nasal tip. Conclusion The horn technique provides greater support to the projection and rotation of rhinoplasties in patients with long and projected nose.

Background: The beauty of nasal tip is very important in septorhinoplasty surgeries. Unstable tip rotation may lead some problems in the outcome of this surgery or performing a repair surgery. Hence, using an appropriate method to save the tip rotation for the long term is considered. Materials and Methods: We studied 30 patients who underwent rhinoplasty in Imam Khomeini Hospital Complex of Tehran and Razi Hospital of Tehran and divided them equally into two groups of rein (case) and septocolumellar (control), randomly. Then, we evaluated the rotation and projection of the nasal tip (nasolabial, columellar-labial, and nasofacial angles) after 2 weeks and 6 months of the surgery. Results: In both groups, 80% and 20% of the patients were female and male, respectively. The reduction of the nasal projection (columellar-labial and nasofacial angles) and nasal rotation (nasolabial angle) was significant in both groups during 6 months after the surgery (P > 0.001) that showed reduction in the nasal projection and rotation after 6 months in both group. This reduction was not significant in the nasofacial and columellar-labial angles (nasal projection) among two groups. However, in the case of nasolabial, we found less reduction in the case group that explains significant relation (P = 0.03). Discussion: Using rein flap can be used as a proper way to save the tip rotation in the long term and could be used in the patients with droopy tip noses. Conclusion: Using rein flap in nasal tissue seems to be effective in providing a stable rotation and projection. This method can be considered as a good option for providing proper projection and rotation. [ABSTRACT FROM AUTHOR]

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.

Objective: Recently, many commercial one-piece alloplastic materials are used in nasal dorsum augmentation and increased nasal tip projection, but there is no study about their effects with regard to size on nasal shape so far. The aim of this study is to evaluate the impact of oversized one-piece alloplastic implant on nasal tip projection. Methods: We categorized nasal tip drooping as primary (group 1: no rhinoplasty or trauma history) and secondary (group 2: previous history of augmentation rhinoplasty with one-piece alloplastic materials), and retrospectively compared the characteristics of primary and secondary nasal tip drooping on the basis of pre- and postoperative rhinological parameters (nasolabial angle [NLA], rotation angle, nasofrontal angle [NFA], and Goode ratio). Results: A total of 50 patients were enrolled and completely reviewed. The mean age was 27.46 years (ranging from 19 to 49 years) in group 1 and 31.33 years (ranging from 20 to 47 years) in group 2. The postoperative NLA and rotation angle were not statistically different between 2 groups, but the postoperative NFA and postoperative Goode ratio were statistically different between 2 groups by independent t test. When we further performed univariate and multivariate analysis, the postoperative Goode ratio was the only factor that was significantly different between the 2 groups. Conclusion: Insertion of one-piece alloplastic implants from nasal tip glabella to dome of nasal tip may induce secondary nasal tip drooping. The degree of recovery of nasal tip projection is different between 2 groups and may be obtained by a more delicate surgical techniques. [ABSTRACT FROM AUTHOR]

Background: Nose is a central structure in midface. It has an important function in maintaining the aesthesis of the face. The threedimensional (3D) structure of the nose is challenging to reconstruct. However, the availability of abundant vascularity and surrounding tissue is advantageous for the reconstruction of the soft tissue. Hence, this study was carried out to assess the cosmetic outcome and acceptability of patients undergoing nasal soft tissue reconstruction using local and regional flaps. Materials and Methods: Patients undergoing nasal soft tissue reconstruction using local or regional flaps, between January 2017 and December 2018, were studied. Patients requiring free flaps or skin grafts for reconstruction were excluded from the study. All the patients during follow-up at 3-6 months were asked to rate cosmetic acceptability and donor site cosmesis as bad, good, and very good. Results: In this study, 15 cases of nasal soft tissue reconstruction were studied. Among the 15 cases, 9 (60%) were male and 6 (40%) were female; the age range of patients was 7-65 years. Majority of the patients (5, 33.3%) had trauma as major cause of deformity. Post malignancy excision defect was the next major cause. All patients were happy with the results, only patient with composite graft complained regarding hyperpigmentation. Conclusion: Nose is an important structure in the midface. Apart from olfaction and respiration, maintaining adequate cosmesis is also an important function of the nose. Any deformity of the nose can be devastating to the patient. But, the 3D structure with varied structures makes reconstruction challenging to recreate. However, the availability of adequate donor tissue in local and surrounding region makes it advantageous. If principles of reconstruction are followed strictly, the outcome is good. Tissue expansion can be used whenever soft tissue requirement is more. [ABSTRACT FROM AUTHOR]

Objectives: It is extremely difficult to obtain ideal tip projection and nose lengthening by septal extension graft using only septal cartilage in Asians, because their nasal septal and alar cartilages are small and weak. Therefore, we introduce a new septal extension graft using a cartilage–bone complex with the vomer and the perpendicular plate of the ethmoid bone as well as cartilage to obtain optimal outcomes. Methods: Participants included 30 patients who underwent surgery by external approach. The septal cartilage, vomer, and perpendicular plate of the ethmoid bone harvested by septoplasty were used. There were 2 layers of cartilage on each side and bone in between to create a strong cartilage–bone complex for projection and lengthening. The bony portion was placed in the tip side, and the double-layered cartilage portion was placed in the inferior portion of the caudal septum of the L-strut to create powerful fixation. Results: There were statistically significant improvements in nasal length (4.71 ± 0.65 vs 5.15 ± 0.53 cm, P value <.0001), tip projection (2.66 ± 0.40 vs 3.18 ± 0.42, P value <.0001), and nasolabial angle (94.0° ± 9.3° vs 107.2° ± 9.6°, P value <.0001) postoperatively. All patients were subjectively satisfied, and 2 different surgeons had excellent or good opinions in 28 (94%) patients. Conclusions: The sandwich technique using cartilage and bone complex results in satisfactory outcomes with stronger tip support, especially in Asians with a weak nasal tip who desire ideal tip projection and dramatic change. [ABSTRACT FROM AUTHOR]

Rhinoplasty is often performed to narrow the nasal tip. Compared with extensive cartilage excision, scoring, and transaction, suture techniques are a favorable method. Suturing techniques offer favorable esthetic and functional outcomes. However, deformities and unnatural appearances may occur if sutures are overtightened or placed incorrectly, and it is possible to inadvertently narrow the external nasal valve and invert the caudal sides of the lateral crura. In this retrospective study, author analyzed the functional and esthetic outcomes of a novel suture method developed to support the external nasal valve by caudocephalic rotation of the lateral crura. The outcomes of the lateral crus caudocephalic rotation suture (CC suture) method were assessed in 24 patients (22 females, two males; age 18–43 years) who underwent primary septorhinoplasty and had iatrogenic or genetic inversion of the caudal sides of the lateral crura. The patients were followed up for 12–36 months. During this time, no serious complications were noted in any patient, and there was no requirement for revision surgery. Satisfactory or acceptable results were obtained in all patients. The CC suture technique is a simple, reversible, and nondestructive technique that benefits from minimal graft use, decreased operation time, improved function and cosmesis, and a short learning curve. Level of evidence: Level V, therapeutic study. [ABSTRACT FROM AUTHOR]