Appendix E – Tip Support, Incisions, and 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 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

1. Tardy ME. R/tinoplasly: the art and the science. Philadelphia : WB Saunders, 1997.
2. 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.