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 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
- Tardy ME. R/tinoplasly: the art and the science. Philadelphia : WB Saunders, 1997.
- Tardy ME, Toriumi DM. Philosophy and principles of rhinoplasty. In: Cummings C.W. Fredrickson JM, Harker LA, et al., eds. Otolaryngology: head & neck surgery. 2nd ed. St. Louis : Mosby Year Book. 1993: 278-294.