Aesthetic Plastic Surgery

, Volume 43, Issue 4, pp 1021–1027 | Cite as

Evaluation of Nasal Tip Support in Septorhinoplasty

  • Ozan ErolEmail author
  • Fuat Buyuklu
  • Alper Koycu
  • Ceren Bas
  • Selim S. Erbek
Original Article Rhinoplasty



A good understanding of nasal tip support mechanisms is essential for achieving successful and functional rhinoplasty results. The loss of nasal tip support resulting from different maneuvers adopted during rhinoplasty and how this loss is affected by reconstructive applications should be known. This study evaluated and compared changes in nasal tip support perioperatively after different techniques were used during septorhinoplasty.


Patients who underwent primary open rhinoplasty between January 2018 and March 2018 in a tertiary medical center were included in this prospective blind case series. Nasal tip resistance measurements were taken after perioperative maneuvers by creating enough force to achieve 1 mm, 2 mm and 3 mm of displacement at the tip region. Measurements were obtained during six different stages using a Newton meter: preoperatively, after caudal septal resection, after skin flap elevation, after the columellar strut or tongue-in-groove procedure, after tip suturing and postoperatively. Our hypothesis was that during septorhinoplasty, each maneuver used changes the tip support intraoperatively. The predictor variables were the different rhinoplasty techniques used. The outcome variable was nasal tip resistance to compression intraoperatively and immediate postoperatively. Appropriate statistics were computed, and a p < 0.05 value was considered significant.


Ten of the 15 patients were female, and 5 were male. The patient age ranged from 19 to 40 (mean 24.8 ± 4.9). The tongue-in-groove technique was applied in 5 of the patients, while columellar strut grafting was performed in 10. The application of columellar strut grafting did not create a significant increase in nasal tip support (p > 0.05). An increase in nasal tip support was observed at each stage (85%, 53%, 35%) after application of the tongue-in-groove technique (p < 0.05).


A novel and reproducible technique for digitally evaluating manual force is presented for determining changes in nasal tip support with different maneuvers applied in living patients undergoing rhinoplasty. No significant difference was noted between the preoperative and postoperative measurements for columellar strut grafting. The tongue-in-groove technique is an important maneuver that has a significant effect on nasal tip support. According to our data, the interdomal and intercrural ligaments, the medial crus–septum connections and the connections between alar cartilage and overlying skin and muscle tissue are important structures for tip support.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Rhinoplasty Nasal tip Tip surgery Tip support Newton meter 



The study protocol was approved by the Başkent University Medical and Health Sciences Research Council and Ethics Committee (project no: KA17/359) and was supported by the Research Fund of Başkent University. Written informed consent was obtained from all patients.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Westreich RW, Lawson W (2008) The tripod theory of nasal tip support revisited: the cantilevered spring model. Arch Facial Plast Surg 10(3):170–179CrossRefGoogle Scholar
  2. 2.
    Janeke JB, Wright WK (1971) Studies on the support of the nasal tip. Arch Otolaryngol 93(5):458–464CrossRefGoogle Scholar
  3. 3.
    Manuel CT, Leary RP, Protsenko DE, Wong BJ (2014) Nasal tip support: a finite element analysis of the role of the caudal septum during tip depression. Laryngoscope 3:649–665CrossRefGoogle Scholar
  4. 4.
    Beaty MM, Dyer WK, Shawl MW (2002) The quantification of surgical changes in nasal tip support. Arch Facial Plast Surg 4:82–91CrossRefGoogle Scholar
  5. 5.
    Gassner HG, Remington WJ, Sherris DA (2001) Quantitative study of nasal tip support and the effect of reconstructive rhinoplasty. Arch Facial Plast Surg 3:178–184CrossRefGoogle Scholar
  6. 6.
    Dobratz EJ, Tran V, Hilger PA (2010) Comparison of techniques used to support the nasal tip and their long-term effects on tip position. Arch Facial Plast Surg 2:172–179Google Scholar
  7. 7.
    Willson TJ, Swiss T, Barrera JE (2015) Quantifying changes in nasal tip support. JAMA Facial Plast 17:428–432CrossRefGoogle Scholar
  8. 8.
    Adamson PA, Litner JA (2006) Applications of the M-arch model in nasal tip refinement. Facial Plast Surg 22:42–48CrossRefGoogle Scholar
  9. 9.
    Tardy ME, Brown RJ (1990) Surgical anatomy of the nose. Raven Press, New YorkGoogle Scholar
  10. 10.
    Han SK, Lee DG, Kim JB, Kim WK (2004) An anatomic study of nasal tip supporting structures. Ann Plast Surg 52:134–139CrossRefGoogle Scholar
  11. 11.
    Gunter JP (1987) Tip rhinoplasty: a personal approach. Facial Plast Surg Clin North Am 4:263–275CrossRefGoogle Scholar
  12. 12.
    McCollough EG, Mangat D (1981) Systematic approach to correction of the nasal tip in rhinoplasty. Arch Otolaryngol 107:12–16CrossRefGoogle Scholar
  13. 13.
    Kridel RW, Scott BA, Foda HM (1999) The tongue-in-groove technique in septorhinoplasty. A 10-year experience. Arch Facial Plast Surg 1:246–256CrossRefGoogle Scholar
  14. 14.
    Daniel RK, Palhazi P (2018) The nasal ligaments and tip support in rhinoplasty: an anatomical study. Aesthet Surg J 38(4):357–368CrossRefGoogle Scholar
  15. 15.
    Shamouelian D, Leary RP, Manuel CT, Harb R, Protsenko DE, Wong BJ (2015) Rethinking nasal tip support: a finite element analysis. Laryngoscope 125:326–330CrossRefGoogle Scholar
  16. 16.
    Bitik O, Uzun H, Kamburoğlu HO, Çaliş M, Zins JE (2015) Revisiting the role of columellar strut graft in primary open approach rhinoplasty. Plast Reconstr Surg 135:987–997CrossRefGoogle Scholar
  17. 17.
    Karaiskakis P, Bromba M, Dietz A, Sand M, Dacho A (2016) Reconstruction of nasal tip support in primary, open approach septorhinoplasty: a retrospective analysis between the tongue in groove technique and the columellar strut. Eur Arch Otorhinolaryngol 273:2555–2560CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  1. 1.Department of OtorhinolaryngologyBaskent University Faculty of MedicineBahcelievler, AnkaraTurkey

Personalised recommendations