Tip with Inadequate projection

A nose with an inadequate projection often looks tip heavy and unbalanced.
Remembering that the underprojecting nasal tip occurs when the measured tip projection is less than 0.67 X ideal nasal length.

Frequent findings in patients with inadequate tip projection are a dorsal hump and weakness of the nasal tip cartilages. This apparent high bridge is misleading as a “Reduction” of the hump removes support from the tip. With loss of this support the tip drops and often in these instances the nasal change is a wider, and elongated appearing nose, with a flattened profile.

The nasal tip may loose additional projection with the reduction of the dorsum further compromising the outcome. These undesirable events are prevented if and I consider it is essential step to add structural support to this cartilage complex.

My preference is to use shaped and elongated cartilage grafts taken from the nasal septum. I fix these grafts using sutures in a manner that allows the lower lateral cartilages to be both stabilized and shaped. When tip projection is maintained or restored in this manner, minimal lowering of the apparent hump is all that is required.

This step to position and support the tip is significant another component in a plan to achieve controlled results in nasal surgery.

These changes are planned by detailed analysis and shown prior to the procedure with computer imaging.