Tip surgery remains the most discussed and least understood aspect of rhinoplasty. To minimize the chance of the reader reaching the same conclusion about this chapter, I will begin with an in-depth discussion of the foundation of tip surgery—the interrelated “3 As” of anatomy, aesthetics, and analysis. The six tip characteristics of volume, width, definition, projection, rotation, and shape will be related to their underlying anatomy and overlying surface aesthetics. One will learn to distinguish the intrinsic tip from the lobule, as well as the influence of intrinsic and extrinsic factors on the tip itself. Then, in perhaps the most controversial aspect of this book, I will present only three tip operations, albeit with numerous variations. These three tip operations are closed volume reduction, open tip sutures, and open tip graft. With these three operations the surgeon can correct 95% of tip deformities. In the second half of this chapter, I will review each of the tip characteristics in detail and provide a graded surgical approach for minor, moderate, and major deformities. These techniques will be illustrated using a “mini-case study” format with emphasis on the tip. If this series of mini-case studies proves insufficient, then the reader can progress to Chapters 7 and 8 to see how one treats the tip as part on an entire nasal problem; i.e., the upwardly rotated tip as part of the short nose deformity. Ultimately, the reader will conclude that tip surgery is the greatest fascination and frustration in all of rhinoplasty.
KeywordsAlar Cartilage Spreader Graft Medial Crura Columella Strut Lateral Crura
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