Tip shaping in primary rhinoplasty: an algorithmic approach.

BACKGROUND Underprojection and lack of tip definition often coexist. Techniques that improve both nasal tip refinement and projection are closely interrelated, and an algorithmic approach can be developed to improve the predictability of the dynamic changes that occur. Use of nondestructive and nonpalpable techniques that enhance nasal tip shape are emphasized. METHODS A retrospective review of primary rhinoplasty patients was undertaken to delineate the precise role of preoperative analysis, intraoperative evaluation, and execution of specific surgical techniques in creating nasal tip refinement and projection. Specific case studies are used to demonstrate the efficacy and predictability of these maneuvers. RESULTS Successful tip refinement and projection depends on (1) proper preoperative analysis of the deformity; (2) a fundamental understanding of the intricate and dynamic relationships between tip-supporting structures that contribute to nasal tip shape and projection; and (3) execution of the operative plan using controlled, nondestructive, and predictable surgical techniques. CONCLUSIONS A simplified algorithmic approach to creating aesthetic nasal tip shape and projection in primary rhinoplasty has been established to aid the rhinoplasty surgeon in reducing the inherent unpredictability of combined techniques and improving long-term aesthetic outcomes.