Nose Tip Correction Surgery
Table of contents
Rhinoplasty is performed for various reasons, one of which, focuses on altering the nasal tip. The tip of the nose comprises of subcutaneous tissues, skin, and paired lower lateral cartilages, thus forming an “M” shape. Rhinoplasty treatment helps to alter several aesthetic features of the nasal tip. It gives the desired results, and provides comfort, and relief to patients, suffering from any nasal inconvenience.
Why People Look for Tip Correction?
There are different reasons behind the need for correcting tip. More often than not, people look for tip correction procedure to:
- Have a well-defined and sculptured nasal tip, along with a suitable angle of nasal-labial (lip)
- Develop a nasal tip which blends well with the rest of nose and facial structure
- Improve the physical appearance of the nose, if that has been a reason to bother
- Improve breathing process, if the structure and angle of the nasal tip, has been interfering in proper breathe-in and breathe-out process
What are the types of deformities found in the nasal tip?
It’s quite usual to have some deformities in the nasal tip. While some defects are right from birth & some are due to accidents. The most common deformities of the nasal tip are:
- Congenital Deformity: Such problems happen since birth. Often, children are born with nasal mass, cleft palate, or cleft lip which disturbs the shape and structure of the nasal tip. It also disturbs the asymmetrical alignment of nose. These abnormalities can be best cured by multiple surgeries.
- Nasal Trauma: Injuries and accidents in nose can be a reason of trauma. Severe accidents and critical injury result in accumulation of blood between the nasal septum and the nose lining. Patients also suffer a nasal bone fracture. Some other symptoms of nasal trauma are septal fracture and deviation, where one side of nose pushes over to the other. All such disorders affect the nasal tip, and loses its aesthetic characteristics. Only by consulting a surgeon, patients can get treated for such problems.
- Prior Nasal Surgery: Previous Rhinoplasty surgery, or other treatments, if go wrong, can disturb the shape, structure, and functionality of the nasal tip. In order to get relief from such woes, patients must go for a second-time surgical process.
- Nasal Mass: Despite any injury or an accident, patients can still develop an internal or external nasal mass, which can alter the shape and position of the nasal tip. These masses might develop cancer, or tumors.
- Medical Conditions: Systemic and nasal medical conditions often bring structural change in nose, which ultimately changes the nasal tip. Disorders in the connective tissue or cartilages can potentially affect the nasal tip.
- Individual Perceptions: In many cases, patients are not satisfied by the shape, size, structure, and other aesthetic features of their nasal tip. This triggers psychological disorders, which make them more conscious about their nasal tip, and they start bothering.
What are the common Tip Correction Grafts?
Columellar Strut Graft:
A commonly used graft in both primary and revision Rhinoplasty surgery, it is a small cartilaginous graft which is harvested from the nasal septal cartilage, in the inside of nose. Such a graft is suitable for propping up a droopy nasal nose, bolstering projection of nasal tip, and preventing sagging.After a Rhinoplasty treatment, this graft provides support to the tip of the nose, and also helps to enhance its projection, if desired by patients. At the same time, it also makes the nasal tip stiffer. Depending on the procedures done during surgery, the relaxing of the nasal tip, in the downward position varies from patients to patients.
Benefits of Columellar Strut Graft:
- Primarily, the graft helps to lift the drooping nasal tip, effectively.
- It also helps to control the angle of projection and rotation of the nasal tip.
- The graft requires smaller amount of cartilage, as compared to other traditional septal extension grafts. Thus, in case of insufficient amount of harvestable septal cartilage, it is an ideal alternative for nasal tip plasty.
- There are no possible complications, and the graft is more effective in treating imperfections within the nasal tip.
Septal Extension Graft:
The septal extension graft is an efficient technique for controlling tip projection, tip rotation, and nasal lengthening. In the grafting procedure, the septal extension graft is fixed to the septum, where it forms a strong supporting structure. During the treatment, surgeons increase the stability of grafts, for more effective long-term results and reduces future complications. The graft is most suitable for the East Asians, since they have less amount of cartilage for harvesting and also possess a weak framework of cartilage.
Benefits of Septal Extension Graft
- First, it helps to lift the drooping nasal tip. It also results in nasal lengthening and provides a strong supporting force to the nasal structure.
- Patients having a surgical objective, are most benefitted by this procedure. It is also more favorable for those having a lower lateral cartilage, or a weak mid-vault.
- Septal extension graft successfully reduces the tip angle from 124.9° to 98.3°, for upturned tip correction candidates.
- In tip projection and lengthening cases, it effectively brings down the average tip angle from 122.4° to 96.8°, and increases tip projection up to 23.2mm.
- It is a more convenient grafting process, which stands by its assured results.
In the overlay grafting procedure, the grafts are placed laterally to the annulus. During the grafting process, surgeons remove the remaining fibrous middle layer, which is located right below the squamous layer; to get a perfect visualization of the anterior meatal recess. This is essential in cases of anterior perforations, which reach out to the anterior annulus. Such a grafting is more difficult to perform, and therefore it is done, only in cases of anterior perforations, total perforations, and failed underlay treatment.
Benefits of Overlay Grafts:
- Overlay grafts help to achieve straight dorsum in patients having crooked nose.
- It finely repairs fractures in nasal bones, disorders in the nasal airway, and avulsions in the lateral cartilages.
- This grafting technique helps patients to quickly recover from nasal trauma, by effectively filling all defects, and creating an illusion of a straight nasal structure.
Lateral/Medial Overlay Grafts:
This graft is more useful for increasing or decreasing the nasal projection. This technique effectively treats long plunging nasal tips, where the lateral crura is overly long. Surgeons mark the domes, and place a 10mm incision, laterally to the dome region. Then, they elevate, overlap, and suture the distal and proximal flaps, in proper place. The amount of overlapping depends on the requirement for de-projecting and rotating the nose. Such grafts are more relevant for patients, who have asymmetrical medial crura or long noses with long medial and lateral crura.
Benefits of Lateral/Medial Overlay Grafts:
- The primary benefit of the treatment lies in bringing appropriate increase or decrease of the projection of nose.
- Lateral or medial overlay grafts help to prevent anterior fall-away of the fascia.
- Patients enjoy good stability, since there’s no need of tight Gelfoam packaging for supporting the graft.
- The grafting procedure also restricts lateralization of the overlay grafts, and therefore it’s more convenient.
- The treatment also results in high supply of blood and faster healing process. It is because surgeons rotate the anterior canal skin like a rotational flap, instead of a free graft.
- Such grafts are easier to perform since only the epithelial layer of the anterior half of the TM remnant is elevated, and not the entire TM.
- Finally, less malleus manipulation is involved in the surgical process.
Shield Graft & Cap Graft:
The purpose of shield graft is to enhance the shape and provide good support to the nasal tip. While performing grafting, the surgeons properly carve the grafts in order to achieve a narrow nasal tip, which is less bulbous and more natural. The shield grafts comprise of cartilage and are usually heart-shaped or pear-shaped. These are placed in the front of the nasal tip to provide more projection to the inserted area. These are more suitable for Indian skin and helps to enhance the tip of the nose.
Benefits of Shield Graft:
- Besides increasing the protection of nasal tip, the shield grafts finely defines the nasal tip, and improves the contour of the infratip area.
- Such grafts are best suited for those having thick skin, and their edged need to be widely beveled for reducing visibility.
- There’s added benefit of morselization, since the extended shield grafts extend anteriorly beyond the domes and provide added protection to the tip of nose.
- After this treatment, patients can also enjoy the comfort of over-rotated nose. It happens due to the use of conchal cartilage which further enhances the pliability and convenes softer contours.
- With this grafting procedure, patients are less likely to face the risk of visible graft silhouette, and get more benefit.
The Diamond Tip method is easier, more convenient and highly flexible in delivering superior results. After undergoing this treatment, patients only need to have an overnight stay in hospital, and then witness fast recovery and healing. After two weeks of grafting, patients bear a natural look, and the results sustain permanently.
Benefits of Diamond Tip:
- Being of modern origin, this technique is most effective, and highly credible. Patients get more comfort and easiness during surgery.
- When combined with Rhinoplasty, patients receive high quality results, and get relief, from all imperfections associated with their nasal tip.