EVALUATION AND MANAGEMENT OF NASAL TIP DISorderS

Anatomy of the nasal tip: The anatomic dome of the nasal tip in reality is a domal segment whose configuration varies from concave to smooth to convex. The alar cartilages can be thought of as three crura (medial, middle, and lateral), each composed of two segments with distinct junction points of aesthetic importance. The medial crura are the pillar on which the nasal tip rests and are the primary component of the columella. Surgical Approaches to the Nasal Tip: 1-Non-delivery approaches traumatize the nasal tip less and therefore cause less tissue swelling intraoperatively. This makes the effects of fine alterations during nasal tip surgery more immediately visible to the surgeon. However, the entire nasal cartilaginous framework cannot be viewed with non-delivery approaches, and so more extensive nasal work cannot be done through this view alone. 2-Delivery approaches which include the “open-nose” approach, allow direct visualization of most of the nasal skeleton and are ideal when extensive tip work must be done. Common forms of tip deformity: Asymetric nasal tip: Nasal tip asymmetries are perceived as abnormalities of the domes or tip-defining points Nasal tip asymmetries have: Vertical dimensions and Horizontal dimensions. Correction of asymmetric nasal tip depending on the type of asymmetry from type I to type IV. Nasal Tip Overprojection Nasal tip projection has been defined as the distance along a perpendicular line from the vertical facial plane to the most anterior projecting point of the nasal tip. When the nose is overprojected, it draws undue attention and the normal nasofacial harmony is disturbed. This overprojection can vary from a subtlety noticed only on close analysis to a grossly overprojected. Broad or Bulbous Nasal Tip: It is a nasal tip that is wide, usually poorly defined, and often associated with an increased width between the tip defining points. CONCLUSION : The dramatic refinement of the nasal tip is a trap for both the patient and the surgeon, who may have unrealistic expectations and unobtainable goals, respectively. The patient must be educated about what is realistic and what is not. Perfection is a dangerous expectation and will lead to disappointment. Multiple techniques are available and must be incorporated with an understanding of the structural and aesthetic impact on adjacent components of the nasal tip and its relationship to the remainder of the nose.