Geometric sculpturing of the thick nasal tip.

Historically, one of the most persistent challenges to the rhinoplastic surgeon has been the thick, heavy, and poorly defined nasal tip. This type of tip is frequently seen in a wide variety of ethnic backgrounds, particularly in Blacks, Hispanics, and Orientals. Attempting improvement through conventional techniques has often resulted in dissatisfied patients and surgeons. Improved definition can be achieved by creating the illusion of a thinner nose rather than actually decreasing the overall size. This article discusses how this is accomplished by a combination of advanced reduction and augmentation techniques including geometric tip defatting, alar cartilage and base reduction, and the use of an ultrasupportive, peapod-shaped tip graft.