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Tip Support, Incisions, & Approaches
Major 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 is also considered a major support mechanism of the nose.]
Minor tip support mechanisms
- Ligamentous sling spanning the domes of the lower lateral cartilages (ie inter-domal 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
- Trans-cartilaginous
- Marginal (NOT to be confused with rim incision)
- Trans-columellar
Approaches – provide surgical exposure
- Cartilage-splitting
- Retrograde
- Delivery – Marginal + inter-cartilaginous incision
- External approach – marginal + trans-columellar incision
Sculpting techniques – surgical modifications
- Complete strip – ie cephalic resection, or volume reduction of lateral crura.
- Incomplete strip (Dome division).
- Transdomal/Domal sutures.
- Augmentation grafting.
- Tip graft.
- Other.
Indications for External Rhinoplasty Approach
- Asymmetric nasal tip
- Crooked nose deformity (lower two thirds of nose)
- Saddle nose deformity
- Cleft-lip nasal deformity
- Secondary rhinoplasty requiring complex structural grafting
- Septal perforation repair
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