the effectiveness of modified vertical dome division technique in reducing nasal tip projection in rhinoplasty

background: the technique of vertical dome division or tip defining, involves incising the lateral crura and vestibular skin at or lateral to the dome or tip defining point. the incision di-vides the lower lateral cartilage into a lateral segment and a medial segment, which are advanced anteriorly and sutured together to increase tip projection. the present study aimed at assessing a new vertical dome division, which is a modified version of vertical dome technique to decrease nasal tip projection, and increase or decrease nasal tip rotation and other tip deformities. methods: the medical files of patients undergone rhinoplasty from 2003 to 2008 were retrospectively analyzed. the files were selected from a computerized rhinoplasty database of patients, who had been operated using a modified vertical dome technique and followed-up for one year or more after the surgery. results: a total of 3756 patients were operated. complications related to the nasal tip such as bossae, bifidity, persistent tip projection or tip asymmetry was seen in 81 patients (2.1%). revisions for tip-related problems were performed in 42 patients (1.1%). conclusions: the findings suggest that the modified vertical dome technique is an effective method for nasal tip deprojection and narrowing via an open approach. the length of follow-up and the large sample size support effectiveness of the technique.