Nasal tip projection. Quantitative changes following rhinoplasty.

Fifty-one patients were enrolled in a study and underwent primary rhinoplasty. Serial nasal tip projection measurements were made preoperatively, intraoperatively, and 6 months postoperatively. Actual changes in measured nasal tip projection were evaluated with respect to preoperative goals and specific procedures used to accomplish these goals in the nasal tip. Several useful observations are made from these data: (1) The most important components of nasal tip projection in the postsurgical nasal tip are the medial crura, their attachment to the caudal septum, and the presence of additional cartilaginous grafts placed between the medial crura or beneath the crural feet. (2) Actual nasal tip projection will decrease postoperatively, unless measures to increase the length and strength of the medial crural segment are taken (ie, McCollough-modified Goldman tip procedure, cartilage struts, plumping grafts, etc), regardless of the preoperative goal. (3) The double-dome unit procedure is effective in narrowing the wide or bulbous lobule but alone does not permanently increase nasal tip projection. (4) Conservative tip procedures, such as a complete strip, result in decreased nasal tip projection and should therefore be used in patients in whom retrodisplacement of the nasal tip is the intended result.