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Paula C: "Ultimately, I chose Dr. Becker because of his dedication and specialization in correcting breathing problems, controlling allery symptoms, and of course, great revision rhinoplasty! Now, with some time having passed, I can only say that I am unbelievably HAPPY with the results. Thanksful that Dr. Becker did such a great job!" Read More
THE SEVERELY TWISTED NOSE
![]() LECTURE ON OSTEOTOMIES
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ยป Appendix E - Tip Support, Incisions, and Approaches
Appendix E - Tip Support, Incisions, and ApproachesMAJOR TIP-SUPPORT MECHANISMS • Size, shape, and strength of lower lateral cartilages • Medial crural footplate attachment to caudal septum • Attachment of caudal border of upper lateral cartilages to cephalic border of lower lateral cartilages [Nasal septum also is considered a major support mechanism of the nose.[ MINOR TIP-SUPPORT MECHANISMS • Ligamentous sling spanning the domes of the lower lateral cartilages (i.e., interdomal ligament) • Cartilaginous dorsal septum • Sesamoid complex of lower lateral cartilages • Attachment of lower lateral cartilages to overlying skin/soft-tissue envelope • Nasal spine • Membranous septum INCISIONS: METHODS OF GAINING ACCESS • Intercartilaginous • Transcartilaginous • Marginal (NOT to be confused with rim incision) • Transcolumellar APPROACHES: PROVIDE SURGICAL EXPOSURE • Cartilage-splitting • Retrograde • Delivery: Marginal + intercartilaginous incision • External approach: Marginal + transcolumellar incision SCULPTING TECHNIQUES: SURGICAL MODIFICATIONS • Complete strip (i.e., cephalic resection) or volume reduction of lateral crura • Incomplete strip (dome division) • Transdomal/domal sutures • Augmentation grafting • Tip graft • Other REFERENCES
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